Organization
PRIMARY CARE MEDICAL CENTER OF GULFPORT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA V MCCLURE (INSURANCE CLERK)
(228) 832-9038
Entity
Organization
Contact information
Practice address
15444 DEDEAUX RD, STE. B, GULFPORT, MS 39503-2637
(228) 832-9038
(228) 832-9990
Mailing address
15444 DEDEAUX RD, STE. B, GULFPORT, MS 39503-2637
(228) 832-9038
(228) 832-9990
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
2083X0100X
Occupational Medicine Physician
—
—
Other
Enumeration date
04/11/2007
Last updated
07/13/2007
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