| NPI | 1225001589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE R MADDERN President 904-398-5437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-09-07 |