| NPI | 1144488628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY DECLUE Director, Provider Services 407-875-2080 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| 207NP0225X Dermatology Pediatric Dermatology | |
| 207Q00000X Family Medicine | |
| 208200000X Plastic Surgery | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2010-08-25 |