| NPI | 1063898864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL VICTOR SHARPE Supervisor 904-783-2405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 1750382669) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 1285048280) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2015-08-04 |