Individual
DR. LYNN LEATHERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15286 COMMUNITY RD, GULFPORT, MS 39503-3509
(228) 832-5151
(228) 832-6320
Mailing address
15286 COMMUNITY RD, GULFPORT, MS 39503-3509
(228) 832-5151
(228) 832-6320
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10834
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114491
—
MS
01
—
110098184
RAILROAD MEDICARE
MS
Enumeration date
03/29/2006
Last updated
04/24/2008
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