| NPI | 1770543076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE E BREWER Director Of Provider Enrollment 877-892-9813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 207VM0101X Obstetrics & Gynecology, Maternal & Fetal Medicine | |
| 207X00000X Orthopaedic Surgery | |
| 208000000X Pediatrics | |
| 2080P0202X Pediatrics, Pediatric Cardiology | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2010-09-23 |