| NPI | 1689158487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT SHAWN BRONKE Enrollment Manager 469-909-6746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2026-02-13 |