| NPI | 1891123949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM JERNBERG President 469-401-2383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2013-10-29 |