| NPI | 1679068118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANN JOHNSON Credentialing Specialist 254-245-9177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2018-06-27 |