| NPI | 1396801569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK A PAYNE Physician Assitant 407-943-7038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA2752) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-08-22 |