| NPI | 1548690936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN D. BAST President 850-377-5268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL pa1962) |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2013-11-21 |