| NPI | 1114951449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN L SHIELDS President 850-380-0481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME45060) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-08-22 |