Organization
MCCOMB SKIN CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA YOUNG BROCK (OFFICE ADMINISTRATOR)
(601) 684-3210
Entity
Organization
Contact information
Practice address
136 MARION AVE, MCCOMB, MS 39648-3620
(601) 684-3210
(601) 684-3319
Mailing address
136 MARION AVE, MCCOMB, MS 39648-3620
(601) 684-3210
(601) 684-3319
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
7285
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014899
—
MS
Enumeration date
05/28/2008
Last updated
07/01/2008
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