| NPI | 1164611943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY PROCTOR Credentialing Specialist 254-559-5140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L3209) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2007-11-30 |