| NPI | 1730757659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWIGHT PEREZ Credentialing Specialist 321-332-6947 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2024-08-16 |