Gulf Coast Dermatology, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

14316 Issued in MS

Legal business name

GULF COAST DERMATOLOGY, PA

Practice address

1304 44TH Ave
Gulfport, MS 39501-2552

Phone

(228) 868-4006

Fax

(228) 868-9545

NPI assigned

Oct 18, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gwendolyn A Crane, M.D.NPI 1417971094

Title

Physician

Phone

(228) 868-4006

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gwendolyn Ann Crane, M.D.

  • Dermatology Physician
  • Gulfport, MS
  • NPI 1417971094
  Medicare reassignment NPD Authorized official
• Eric Carl Torp, M.D.

  • Dermatology Physician
  • Ocean Springs, MS
  • NPI 1841300175
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1376532788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 44TH AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012552",
            "telephone_number": "228-868-4006",
            "fax_number": "228-868-9545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 44TH AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012552",
            "telephone_number": "228-868-4006",
            "fax_number": "228-868-9545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "CRANE",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "228-868-4006",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MS",
            "license": "14316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04922734",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "070007893",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gulf Coast Anesthesia Services PC
• Gulf Coast Brain & Spine Institute
• Gulf Coast Companion Care, LLC
• Gulf Coast Dental Care, PLLC
• Gulf Coast Dental Center
• Gulf Coast Ear Nose and Throat Associates, LLC
• Gulf Coast Endocrinology
• Gulf Coast Endodontic Associates, LLC
• Gulf Coast Imaging
• Gulf Coast Interventional Pain Management Clinic, Inc

• Dermatology Physician in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Dermatology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.