| NPI | 1346731676 |
|---|---|
| Doing Business As | JUSTIN MEDICAL |
| Doing Business As | PONDER MEDICAL |
| Doing Business As | NORTHLAKE MEDICAL |
| Entity Type | Organization |
| Authorized Contact | KEVIN DAVIS Member 940-368-7769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2018-06-16 |