| NPI | 1790847077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK B SHUMATE Physician 850-872-1300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: FL ME21390) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-08-22 |