| NPI | 1790755320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN SOUTHWORTH Md 662-377-2663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery, Hand Surgery |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-12-09 |