| NPI | 1386639912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILLIAN OWENS Credentialing And Contracting 850-689-1740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME0061435) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2025-03-14 |