| NPI | 1558003152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANE TRASK Of CEO 813-747-1128 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery Hand Surgery |
| 207XX0005X Orthopaedic Surgery Sports Medicine | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine | |
| 213E00000X Podiatrist | |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-04-13 |