| NPI | 1093174286 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP - GULF SHORES |
| Entity Type | Organization |
| Authorized Contact | TODD KENNEDY President 251-633-8880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2016-02-16 |