| NPI | 1689707655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY CARSON Manager, Payer Enrollment 234-312-5691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207VX0201X Obstetrics & Gynecology Gynecologic Oncology | |
| 208200000X Plastic Surgery | |
| 1041C0700X Social Worker Clinical | |
| 207RC0000X Internal Medicine Cardiovascular Disease | |
| 207RG0300X Internal Medicine Geriatric Medicine | |
| 207RP1001X Internal Medicine Pulmonary Disease | |
| 363A00000X Physician Assistant | |
| 2086S0129X Surgery Vascular Surgery | |
| 207VF0040X Obstetrics & Gynecology Female Pelvic Medicine and Reconstructive Surgery | |
| 213ES0103X Podiatrist Foot & Ankle Surgery | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2025-09-03 |