| NPI | 1093241671 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP - ENT |
| Entity Type | Organization |
| Authorized Contact | ERICA MADISON Credentialing Specialist 251-342-3949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2017-05-03 |