| NPI | 1477073617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSIA MAE BEDGOOD Managing Member 512-413-1402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX N9171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N9171) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2019-08-13 |