| NPI | 1790030419 |
|---|---|
| Doing Business As | SOONER ROAD FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | MICHAEL L GINGRAS Credentialing Manager 239-598-3131 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2012-11-27 |