| NPI | 1881579522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONE MCCLOUD Executive Director 904-202-5367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 207XX0005X Orthopaedic Surgery Sports Medicine | |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-08-11 |