| NPI | 1003851502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVA D. WIDDIS Administrator 352-787-9838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2020-06-05 |