| NPI | 1134371669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEFRITA LOGAN Credentialing COO Rdinator 407-875-2080 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2011-11-16 |