| NPI | 1427486562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL S RANALLO Secretary 270-417-4813 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 208800000X Urology | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2023-01-16 |