| NPI | 1871954214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD EUGENE PETERS Authorized Official 541-323-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD25927) |
| Enumeration Date | 2016-03-13 |
| Last Update Date | 2016-03-13 |