| NPI | 1376581900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH I PORTER Director Of Provider Enrollment 817-451-4208 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2020-12-28 |