| NPI | 1306957378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN WIDICK SMALLWOOD President 321-784-8811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology |
| 207NP0225X Dermatology, Pediatric Dermatology | |
| 207NS0135X Dermatology, Procedural Dermatology | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |