| NPI | 1063725356 |
|---|---|
| Doing Business As | MEDSTREAM WELLNESS MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | VICKI B DAVIS Medical Director 972-377-2447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F9213) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX F9213) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2010-07-15 |