| NPI | 1124247853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEBA O. CUNNINGHAM Insurance Rep. 870-802-3376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2014-05-28 |