Organization
GULFPORT SURGERY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS PAUL MACE M.D. (OWNER)
(228) 822-6160
Entity
Organization
Contact information
Practice address
1312 44TH AVE, GULFPORT, MS 39501-2552
(228) 822-6160
(228) 539-8327
Mailing address
1312 44TH AVE, GULFPORT, MS 39501-2552
(228) 822-6160
(228) 539-8327
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
13995
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00383374
—
MS
Enumeration date
08/10/2006
Last updated
06/11/2020
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