NPI | 1013681196 |
---|---|
Entity Type | Organization |
Authorized Contact | VICKI SOULE CEO 772-257-8224 |
Organization Subpart ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 207R00000X Internal Medicine |
207VG0400X Obstetrics & Gynecology, Gynecology | |
208000000X Pediatrics | |
Enumeration Date | 2021-08-03 |
Last Update Date | 2022-03-22 |