NPI | 1902593809 |
---|---|
Entity Type | Organization |
Authorized Contact | TYRONE MEDINA Md 239-649-3333 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2023-04-20 |
Last Update Date | 2025-05-01 |