Organization
MEDICAL FOUNDATION OF SOUTH MISSISSIPPI
Active
Other names
Weaver Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY ROBINSON (ADMINISTRATOR)
(228) 865-1453
Entity
Organization
Contact information
Practice address
1612 31ST AVE, GULFPORT, MS 39501-2750
(228) 865-1453
(228) 865-1451
Mailing address
1612 31ST AVE, GULFPORT, MS 39501-2750
(228) 865-1453
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14403
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9014378
—
MS
01
—
CM1261
RAILROAD MEDICARE
MS
Enumeration date
08/28/2006
Last updated
02/01/2008
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