{"npi":"1376532788","type":"NPI-2","status":"active","name":{"display":"Gulf Coast Dermatology, PA","other":[],"organization_name":"GULF COAST DERMATOLOGY, PA","authorised_official":"Gwendolyn Crane"},"specialty":{"primary_taxonomy":"207N00000X","primary_taxonomy_description":"Dermatology","slug":"dermatology","schema_org_specialty":"Dermatologic","all":[{"code":"207N00000X","description":"Dermatology","primary":true,"state":"MS","license":"14316"}]},"addresses":[{"purpose":"LOCATION","street_1":"1304 44TH AVE","city":"GULFPORT","state":"MS","postal_code":"395012552","country_code":"US","phone":"2288684006","fax":"2288689545"},{"purpose":"MAILING","street_1":"1304 44TH AVE","city":"GULFPORT","state":"MS","postal_code":"395012552","country_code":"US","phone":"2288684006","fax":"2288689545"}],"license":{"state":"MS","number":"14316"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"04922734","state":"MS","issuer":null},{"type_code":"01","label":"Other","value":"070007893","state":"MS","issuer":"MEDICARE RR"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20080903000158","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"MS","pac_id":"0648346494"}]},"enumeration_date":"2005-10-18","last_updated":"2009-08-20","_meta":{"source":"NPPES","snapshot_date":"2009-08-20","doc_url":"https://findmynpi.com/api"}}