NPI | 1619503026 |
---|---|
Entity Type | Organization |
Authorized Contact | CLIVE FIELDS Cmo 346-766-0604 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 207R00000X Internal Medicine |
363A00000X Physician Assistant | |
363L00000X Nurse Practitioner | |
Enumeration Date | 2020-03-17 |
Last Update Date | 2023-08-22 |