Organization
SOUTHPORT SURGICAL ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY FELIX WEISNER (PRESIDENT)
(910) 457-1880
Entity
Organization
Contact information
Practice address
621B N FODALE AVE, SOUTHPORT, NC 28461-3550
(910) 457-1880
Mailing address
621B N FODALE AVE, SOUTHPORT, NC 28461-3550
(910) 457-1880
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9400669
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
790156Q
—
NC
Enumeration date
05/24/2007
Last updated
08/22/2020
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