| NPI | 1851515878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY ALLEN EBERLY Physician 251-943-7901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 21260) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 18394) |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 1-050138) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2008-04-20 |