| NPI | 1043758782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE TATAW BESONG President & CEO 386-747-9771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME074829) | |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology (Licence: FL ME92729) | |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2017-02-01 |