| NPI | 1912637786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER RANDALL Md Owner 928-600-0479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2024-12-05 |