| NPI | 1942757620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE ZIMMER Credentialing Specialist 956-627-1258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2016-09-09 |
| Last Update Date | 2016-09-09 |