| NPI | 1417062613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY S RIVENBARK Owner 850-279-4917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA GA11411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA GA051731) |
| 208M00000X Hospitalist (Licence: GA GA11411) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2012-08-29 |