Individual
WAKKAS TAYARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1391 BROAD AVE, GULFPORT, MS 39501-2419
(228) 392-7429
(228) 396-3830
Mailing address
1720A MEDICAL PARK DR, SUITE 340, BILOXI, MS 39532-2129
(228) 392-7429
(228) 396-3830
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
18677
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124636
—
MS
Enumeration date
07/02/2006
Last updated
01/14/2010
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