| NPI | 1962555490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODY BOSTIC Practice Administrator 904-733-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Additional Taxonomies | 207RI0011X Internal Medicine, Interventional Cardiology |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2016-09-01 |