| NPI | 1659307791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE T BREWER Director Of Provider Enrollment 877-892-9813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine Infectious Disease |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 207RC0000X Internal Medicine Cardiovascular Disease | |
| 207RP1001X Internal Medicine Pulmonary Disease | |
| 207VX0000X Obstetrics & Gynecology Obstetrics | |
| 207X00000X Orthopaedic Surgery | |
| 208000000X Pediatrics | |
| 2084N0400X Psychiatry & Neurology Neurology | |
| 208600000X Surgery | |
| 208800000X Urology | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2008-11-25 |