Organization
CYRIL VK BETHALA, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CYRIL V.K. BETHALA M.D. (OWNER)
(228) 863-9999
Entity
Organization
Contact information
Practice address
4507 15TH ST, GULFPORT, MS 39501-2500
(228) 863-9999
(228) 863-9955
Mailing address
4507 15TH ST, GULFPORT, MS 39501-2500
(228) 863-9999
(228) 863-9955
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
16691
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08539298
—
MS
01
—
DP7857
RAILROAD MEDICARE
MS
Enumeration date
07/09/2009
Last updated
07/29/2010
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