Organization
THE DERMATOLOGY CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA B WINGFIELD MD (OWNER/PHYSICIAN)
(228) 864-3300
Entity
Organization
Contact information
Practice address
11295 EAST TAYLOR ROAD, GULFPORT, MS 39503
(228) 864-3300
(228) 864-3333
Mailing address
P.O. BOX 6625, GULFPORT, MS 39506-6625
(228) 864-3300
(228) 864-3333
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
17831
TX
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00874879
—
MS
05
—
06375287
—
MS
01
—
25D1013637
CLIA
—
Enumeration date
06/25/2007
Last updated
10/22/2024
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