| NPI | 1063457273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER NICHOLE DOCKENEY Credentialing Supervisor 352-372-9414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| 208200000X Plastic Surgery | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2023-01-12 |