| NPI | 1760055289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANELLE FISCHER Administrator 850-479-1805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology |
| 2085R0204X Radiology, Vascular & Interventional Radiology | |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2021-07-22 |