Provider Demographics
NPI:1770670333
Name:GULF COAST BRAIN & SPINE INSTITUTE
Entity type:Organization
Organization Name:GULF COAST BRAIN & SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-867-4856
Mailing Address - Street 1:1340 BROAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501
Mailing Address - Country:US
Mailing Address - Phone:228-867-4856
Mailing Address - Fax:228-867-4857
Practice Address - Street 1:1340 BROAD AVENUE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-867-4856
Practice Address - Fax:228-867-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18374207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08253741Medicaid
E47951Medicare UPIN