| NPI | 1366834749 |
|---|---|
| Doing Business As | COASTAL PLAIN ENT |
| Entity Type | Organization |
| Authorized Contact | DETRA RENEE SAFFOLD Regional Practice Administrator 757-821-2090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110001371) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2015-02-23 |