Organization
GARDEN PARK PHYSICIAN SERVICES CORP
Active
Other names
Family Medical Center of Orange Grove
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LAGESSE (VICE PRESIDENT)
(504) 988-7044
Entity
Organization
Contact information
Practice address
12330 ASHLEY DR, GULFPORT, MS 39503-2737
(228) 863-7117
(228) 868-9388
Mailing address
12330 ASHLEY DR, GULFPORT, MS 39503-2737
(228) 863-7117
(228) 868-9388
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016019
—
MS
Enumeration date
07/03/2006
Last updated
10/10/2007
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