| NPI | 1417252594 |
|---|---|
| Former Legal Business Name | MID-SOUTH PEDIATRIC UROLOGY PC |
| Entity Type | Organization |
| Authorized Contact | HERBERT VICTOR BRAREN President 615-321-0481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 2088P0231X Urology, Pediatric Urology |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2011-01-20 |