| NPI | 1124026489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM EARL HICKS Partner 712-754-3658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 18374) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IA 18374) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IA 18374) | |
| 207Q00000X Family Medicine (Licence: IA 18381) | |
| 207Q00000X Family Medicine (Licence: IA 02364) | |
| 207Q00000X Family Medicine (Licence: IA 02096) | |
| 207Q00000X Family Medicine (Licence: IA 3511) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2009-07-23 |