| NPI | 1477377026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH C DUMAS Manager 386-758-8937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 207R00000X Internal Medicine | |
| 208600000X Surgery | |
| Enumeration Date | 2024-11-11 |
| Last Update Date | 2025-04-10 |