| NPI | 1598157067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA THURMAN Administrator 941-925-3627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9108514) |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2019-01-03 |