| NPI | 1134347958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMMICILE DEAN ROGERS Administrator 662-843-3606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2008-02-05 |