| NPI | 1730819145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA LONG Credentialing Manager 501-223-2776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RR0500X Internal Medicine Rheumatology |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2023-03-23 |