NPI | 1215932520 |
---|---|
Entity Type | Organization |
Authorized Contact | ELENA ORAVETZ Credentialing 904-384-2240 |
Organization Subpart ? | No |
Primary Taxonomy | 174400000X Specialist |
Additional Taxonomies | 208D00000X General Practice |
Enumeration Date | 2005-06-15 |
Last Update Date | 2024-06-21 |