Organization
INTERNAL MEDICINE CLINIC OF PICAYUNE
Active
Other names
The Center For Health Management
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANFORD OWEN MD (MD)
(228) 864-9669
Entity
Organization
Contact information
Practice address
3300 15TH ST, GULFPORT, MS 39501-3901
(228) 864-9669
(228) 864-9774
Mailing address
3300 15TH ST, GULFPORT, MS 39501-3901
(228) 864-9669
(228) 864-9774
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
08597
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05324518
—
MS
Enumeration date
06/21/2006
Last updated
08/22/2020
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