| NPI | 1720962871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIED M EBSWORTH Director 863-738-6601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2086S0129X | |
| 213ES0131X | |
| Enumeration Date | 2025-08-02 |
| Last Update Date | 2025-09-27 |