| NPI | 1245039940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BULLOCK Authorized Official 385-455-7170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2025-03-13 |
| Last Update Date | 2026-03-05 |