| NPI | 1922115914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY DOMAYER CFO 386-231-3906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology |
| 207Q00000X Family Medicine | |
| 207RP1001X Internal Medicine Pulmonary Disease | |
| 207V00000X Obstetrics & Gynecology | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2022-04-28 |