| NPI | 1346825213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERTRAM F SIMMONS Owner 321-527-8016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2021-03-12 |