| NPI | 1649420787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NINETY NINE CREDENTIALING SERVICES Credentialing 972-792-5700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K2988) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2022-07-21 |