| NPI | 1942646146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER NICHOLE DOCKENEY Credentialing Supervisor 352-372-9414 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2023-01-12 |