| NPI | 1427009638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY CARSON Manager, Payer Enrollment 234-312-5691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| 207RB0002X Internal Medicine Obesity Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-08-14 |