Organization
GULF COAST ASTHMA AND ALLERGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS CLINTON LEAVENGOOD MD (PRESIDENT)
(228) 432-5955
Entity
Organization
Contact information
Practice address
1025 DIVISION ST, SUITE D, BILOXI, MS 39530-2906
(228) 432-5955
(228) 432-5952
Mailing address
1025 DIVISION ST, SUITE D, BILOXI, MS 39530-2906
(228) 432-5955
(228) 432-5952
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
11243
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00110476
—
MS
Enumeration date
09/21/2006
Last updated
03/07/2023
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