| NPI | 1568993855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK PAYSON Practice Director 5717-892-1005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VE0102X Obstetrics & Gynecology, Reproductive Endocrinology (Licence: VA 0101243183) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2017-03-27 |