| NPI | 1164052957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LA TOYA DAWSON Credenitaling Specialist 352-231-7551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2021-02-04 |