| NPI | 1205959376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDY DOORNBOS Billing And Credentialing 727-816-9427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME58035) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2020-08-22 |