NPI | 1245872514 |
---|---|
Entity Type | Organization |
Authorized Contact | TIMOTHY WAYNE BODEN Executive Director 662-256-9331 |
Organization Subpart ? | Yes |
Primary Taxonomy | 208000000X Pediatrics |
Additional Taxonomies | 207R00000X Internal Medicine |
Enumeration Date | 2019-10-08 |
Last Update Date | 2019-10-08 |