Organization
COAST CARDIOTHORACIC SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IRAKLIS SPYRIDONOS GEROGIANNIS M.D. (MEMBER)
(228) 822-1151
Entity
Organization
Contact information
Practice address
1308 44TH AVE, GULFPORT, MS 39501-2552
(228) 822-1151
(228) 822-1213
Mailing address
1308 44TH AVE, GULFPORT, MS 39501-2552
(228) 822-1151
(228) 822-1213
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
17121
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0123845
—
MS
Enumeration date
01/29/2008
Last updated
01/29/2008
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