| NPI | 1831308816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE T BREWER Director Of Provider Enrollment 877-892-9813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208600000X Surgery | |
| 208800000X Urology | |
| 208D00000X General Practice | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2008-10-01 |