| 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 | 2025-04-01 |