| NPI | 1336553619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE HUBBARD Manager 904-716-5102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME76595) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2021-06-30 |