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 |
207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
2086S0122X Surgery, Plastic and Reconstructive Surgery | |
261QM1300X Clinic/Center, Multi-Specialty | |
Enumeration Date | 2012-05-15 |
Last Update Date | 2024-07-11 |