| NPI | 1780861781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL EDWARD LUTZ President 904-737-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Additional Taxonomies | 207N00000X Dermatology |
| 207ND0900X Dermatology, Dermatopathology | |
| 207NS0135X Dermatology, Procedural Dermatology | |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2012-12-21 |