| NPI | 1023529120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY AMBER HOWINGTON Credentialing Department 580-775-5857 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q7044) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX Q7044) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX Z7044) | |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2017-10-16 |