| NPI | 1598135451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK MCCOY President 352-214-7180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0054001) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: CO 0054001) |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: CO 0054001) | |
| Enumeration Date | 2015-10-04 |
| Last Update Date | 2021-01-12 |