| NPI | 1386848356 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | CLARK P. CHRISTIANSON President 251-633-1660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 207RR0500X Internal Medicine, Rheumatology | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2012-09-13 |