| NPI | 1396138319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIOLA JACOBS Owner 321-946-6864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME90116) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME85807) |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2015-03-16 |