| NPI | 1568504173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON W THACKERAY Physician 850-863-2153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME77615) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-10-29 |