| NPI | 1043270150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA WINES Director, Credentialing 567-585-0422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 152W00000X Optometrist |
| 207R00000X Internal Medicine | |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| 207RS0012X Internal Medicine, Sleep Medicine | |
| 207RS0012X Internal Medicine, Sleep Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 207W00000X Ophthalmology | |
| 207Y00000X Otolaryngology | |
| 208600000X Surgery | |
| 2086S0129X Surgery, Vascular Surgery | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2023-10-04 |