Organization
GULFPORT OBSTETRICAL & GYNECOLOGICAL CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID P BURKART (ADMINISTRATOR)
(228) 863-9977
Entity
Organization
Contact information
Practice address
4502 OLD PASS RD, GULFPORT, MS 39501-2585
(228) 863-9977
(228) 822-2174
Mailing address
4502 OLD PASS RD, GULFPORT, MS 39501-2585
(228) 863-9977
(228) 822-2174
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
82612
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013169
—
MS
Enumeration date
12/28/2005
Last updated
08/22/2020
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