| NPI | 1558786830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNNE CHRISTINE FISCUS Cmo 984-215-4111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 208800000X Urology | |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2019-08-14 |