| NPI | 1053688515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY C. GAINES Owner 352-333-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME76402) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME76402) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2016-11-17 |