| NPI | 1093986937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA DAVENPORT Insurance Credentialing Supervisor 512-681-3460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 2208) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 2208) |
| 363A00000X Physician Assistant (Licence: OK 2208) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 2208) | |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2008-07-23 |