| NPI | 1275066912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE ZIMMER Credentialing Specialist 956-561-4894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| 213E00000X Podiatrist | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2017-04-10 |