| NPI | 1851870208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE DURRETT Office Manager 424-352-0049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 028306) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 028306) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2018-08-20 |