| NPI | 1922469543 |
|---|---|
| Doing Business As | ULTRA HEALTH PROVDERS |
| Entity Type | Organization |
| Authorized Contact | CHARLES RICHARD JERMAN Member 731-234-8120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2018-08-29 |