| NPI | 1831956663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DACOSTA Owner 270-344-5473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2024-03-20 |