1285929406 NPI number — DR. RAYMOND MONSOUR SCURFIELD MSW, DSW

Table of content: DR. RAYMOND MONSOUR SCURFIELD MSW, DSW (NPI 1285929406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285929406 NPI number — DR. RAYMOND MONSOUR SCURFIELD MSW, DSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCURFIELD
Provider First Name:
RAYMOND
Provider Middle Name:
MONSOUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, DSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285929406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15465 OAK LN STE 100G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULFPORT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39503-2663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-314-3626
Provider Business Mailing Address Fax Number:
228-314-3141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1403 43RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-897-7730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C6013 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08186200 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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