| NPI | 1326647504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE ROGERS Practice Administrator 904-619-3048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2020-10-20 |