| NPI | 1003419763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN PAUL JAMES SHADDOCK Director Of Network Managment 850-341-6322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2020-11-17 |