Provider Demographics
NPI:1114262748
Name:GULF COAST SURGICAL SPECIALISTS INC
Entity Type:Organization
Organization Name:GULF COAST SURGICAL SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARAN
Authorized Official - Middle Name:JENNINGS
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-463-0444
Mailing Address - Street 1:3715 DAUPHIN ST
Mailing Address - Street 2:BLDG 2, SUITE 7-B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1775
Mailing Address - Country:US
Mailing Address - Phone:251-340-7880
Mailing Address - Fax:251-340-7881
Practice Address - Street 1:3715 DAUPHIN ST
Practice Address - Street 2:BLDG 2, SUITE 7-B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1775
Practice Address - Country:US
Practice Address - Phone:251-340-7880
Practice Address - Fax:251-340-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-08
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29026208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL106150Medicaid
AL510I020047Medicare Oscar/Certification