| NPI | 1447641592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN THOMAS MCKIBBEN Healthcare Provider 904-353-5921 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME40936) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2015-02-11 |