| NPI | 1811917628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORIS B. KELLEY Medical Assistant 850-769-2417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: FL ME104621) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME0051595) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2011-12-12 |