| NPI | 1366099269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KAY PAGE Credentialing Manager 731-693-3465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2019-08-25 |
| Last Update Date | 2023-09-14 |