| NPI | 1477089613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNNE CHRISTINE FISCUS Cmo 984-215-4111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 207P00000X Emergency Medicine | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 207X00000X Orthopaedic Surgery | |
| 207Y00000X Otolaryngology | |
| 208000000X Pediatrics | |
| 2084B0002X Psychiatry & Neurology, Bariatric Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2084S0010X Psychiatry & Neurology, Sports Medicine | |
| 208600000X Surgery | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery | |
| 208800000X Urology | |
| Enumeration Date | 2017-05-09 |
| Last Update Date | 2019-08-14 |