| NPI | 1437552015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNNE CHRISTINE FISCUS Cmo 984-215-4111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| 207RI0200X Internal Medicine, Infectious Disease | |
| 207RR0500X Internal Medicine, Rheumatology | |
| 207T00000X Neurological Surgery | |
| 207V00000X Obstetrics & Gynecology | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 208000000X Pediatrics | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| 208800000X Urology | |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2019-08-14 |