| NPI | 1386215002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY WARREN Member 727-221-6415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Enumeration Date | 2021-07-03 |
| Last Update Date | 2024-12-06 |