Individual
MR. LAKEDRIAN GUY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
980 COURTHOUSE RD APT 1521, GULFPORT, MS 39507-4298
(850) 450-7044
Mailing address
980 COURTHOUSE RD APT 1521, GULFPORT, MS 39507-4298
(850) 450-7044
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
07/13/2012
Last updated
07/13/2012
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