| NPI | 1124152236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOB JACOB Owner 501-513-2628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology (Licence: AR MC-2479) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2018-08-01 |