NPI | 1912728734 |
---|---|
Entity Type | Organization |
Authorized Contact | IAN C LAMPKIN Credentialing Pe Specialist 667-303-1042 |
Organization Subpart ? | No |
Primary Taxonomy | 207R00000X Internal Medicine |
Additional Taxonomies | 207Q00000X Family Medicine |
363A00000X Physician Assistant | |
363L00000X Nurse Practitioner | |
Enumeration Date | 2024-10-23 |
Last Update Date | 2024-10-23 |