| NPI | 1811416530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAGE MCCALISTER Billing & Credentialing Manager 725-200-3232 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Additional Taxonomies | 207K00000X Allergy & Immunology |
| 213E00000X Podiatrist | |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2019-02-14 |