| NPI | 1124424098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY L DARSTEK CEO 239-898-3836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine |
| 207QA0505X Family Medicine, Adult Medicine | |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| 207R00000X Internal Medicine | |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2014-11-05 |