Organization
MEDICAL FOUNDATION OF SOUTH MS
Active
Other names
Southern Coast Family Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY ROBINSON (ADMINISTRATOR)
(228) 865-1453
Entity
Organization
Contact information
Practice address
394 COURTHOUSE RD, SUITE A, GULFPORT, MS 39507-1865
(228) 896-4417
(228) 865-1457
Mailing address
1612 31ST AVE, GULFPORT, MS 39501-2750
(228) 865-1453
(228) 865-1457
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014940
—
MS
Enumeration date
12/04/2008
Last updated
12/04/2008
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