| NPI | 1003812629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALLACE A BLACKBURN Office Manager 813-873-7106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: FL 31997.0000) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2008-09-11 |