NPI | 1508878083 |
---|---|
Doing Business As | PROVIDENCE MEDICAL GROUP |
Entity Type | Organization |
Authorized Contact | CLARK P. CHRISTIANSON President 251-633-1660 |
Organization Subpart ? | No |
Primary Taxonomy | 207R00000X Internal Medicine |
Additional Taxonomies | 207RR0500X Internal Medicine, Rheumatology |
207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
207RG0100X Internal Medicine, Gastroenterology | |
207VX0201X Obstetrics & Gynecology, Gynecologic Oncology | |
207Q00000X Family Medicine | |
Enumeration Date | 2006-08-12 |
Last Update Date | 2012-10-08 |