Organization
DIVERSIFIED MEDICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY SALVATORE BROCATO JR. (BUSINESS MANAGER)
(985) 249-1683
Entity
Organization
Contact information
Practice address
2305 S PURPERA AVE, GONZALES, LA 70737-5427
(225) 644-1028
Mailing address
106 TENTH ST, BAY ST LOUIS, MS 39520-2409
(985) 249-1683
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/04/2020
Last updated
03/04/2020
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