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Individual

RICHARD J PADDOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1340 BROAD AVE, SUITE 210, GULFPORT, MS 39501
(228) 575-1600
(228) 575-1603
Mailing address
PO BOX 1810, GULFPORT, MS 39502
(228) 575-1600
(228) 575-2917

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
015310
LA
208800000X
Urology Physician
Primary
32690
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1335169
LA
Enumeration date
08/18/2005
Last updated
02/15/2024
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