| NPI | 1134409832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS HUNTER NEWSOM Manager 863-385-1544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck |
| Additional Taxonomies | 207W00000X Ophthalmology |
| 208200000X Plastic Surgery | |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2012-10-30 |