| NPI | 1497622575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL P. DEEL Owner 276-220-8861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2025-10-22 |
| Last Update Date | 2025-12-04 |