| NPI | 1417013707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON RYAN JACKSON President 239-598-9009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 208200000X Plastic Surgery |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2023-02-17 |