| NPI | 1477672442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRIS STACKER CEO 662-378-3783 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease |
| 207V00000X Obstetrics & Gynecology | |
| 2086S0129X Surgery, Vascular Surgery | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2022-11-14 |