Organization
SOUTHERN UROLOGY ASSOCIATES LLC
Active
Other names
Southern Urology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J. LAGEESE (VP)
(504) 988-7044
Entity
Organization
Contact information
Practice address
15190 COMMUNITY RD, SUITE 260, GULFPORT, MS 39503-3485
(228) 539-0071
(228) 539-0722
Mailing address
15190 COMMUNITY RD, SUITE 260, GULFPORT, MS 39503-3485
(228) 539-0071
(228) 539-0722
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275576
—
MS
Enumeration date
06/12/2006
Last updated
06/21/2018
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