| NPI | 1225475536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY MICHAEL HANTES Physician 817-731-3936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2013-05-28 |