| NPI | 1528892049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA WAGENER Owner/Authorized Official 407-624-2844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| Enumeration Date | 2024-08-27 |
| Last Update Date | 2024-11-12 |