| NPI | 1306105150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRAINE MCCUNE Credentialing Specialist 567-585-1964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine |
| 207RH0003X Internal Medicine, Hematology & Oncology | |
| 2086S0129X | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 207RS0012X Internal Medicine, Sleep Medicine | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery | |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| 207Y00000X Otolaryngology | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| 207RI0200X Internal Medicine, Infectious Disease | |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2025-12-16 |