| NPI | 1659764850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE GRAHAM Credentialing Specialist 972-245-1315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-12 |