Organization
GARDEN PARK PHYSICIAN GROUP-SPECIALTY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD CARLON (VP)
(816) 508-4090
Entity
Organization
Contact information
Practice address
15190 COMMUNITY RD, SUITE 330, GULFPORT, MS 39503-3485
(228) 539-9100
(228) 539-9133
Mailing address
15190 COMMUNITY RD, SUITE 330, GULFPORT, MS 39503-3485
(228) 539-9100
(228) 539-9133
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01681729
—
MS
05
—
3576014
—
MS
Enumeration date
10/04/2006
Last updated
03/07/2013
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