| NPI | 1790181550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD THACKER Physician 850-878-8235 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL ARNP9188795) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2014-11-06 |