| NPI | 1285023309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA GOODRIDGE SHEPARD Doctor/Practice Co Owner 239-449-9882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME076050) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME0053566) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-01-13 |