| NPI | 1912229956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES GILLIS PURGASON President 817-917-9687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J6672) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: TX J6672) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX M8858) | |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2016-09-07 |