Organization
INTERNAL MEDICINE GROUP OF THE MIDSOUTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AILEEN S GAYOSO MD (PRESIDENT)
(662) 536-1520
Entity
Organization
Contact information
Practice address
391 SOUTHCREST CL, SUITE 210, SOUTHAVEN, MS 38671
(662) 536-1520
Mailing address
391 SOUTHCREST CL, 210, SOUTHAVEN, MS 38671
(662) 536-1520
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15680
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160334001
—
AR
Enumeration date
06/06/2008
Last updated
06/06/2008
Update your record
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