| NPI | 1639681737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY HOWINGTON Credentialing Specialist 580-775-5857 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine | |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2017-10-30 |