Individual
DR. ANGELA BOOTH WINGFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11295 E TAYLOR RD, GULFPORT, MS 39503-4197
(228) 864-3300
Mailing address
11295 E TAYLOR RD, GULFPORT, MS 39503-4197
(228) 864-3300
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
024878
LA
207NS0135X
Procedural Dermatology Physician
Primary
1731
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00874879
—
MS
01
—
25D1013637
CLIA
—
Enumeration date
08/23/2005
Last updated
12/12/2022
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