| NPI | 1528467693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB B. REDEKOP Medical Doctor 520-299-2248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ 4770) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: AZ 4770) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2014-08-14 |