| NPI | 1396876355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE T BREWER Director Of Provider Enrollment 877-892-9813 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 363LF0000X Nurse Practitioner, Family | |
| 208800000X Urology | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2009-10-21 |