| NPI | 1003361767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL TAVERNARIS Physician 850-396-1110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL me116308) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2024-09-27 |