| NPI | 1972028843 |
|---|---|
| Former Legal Business Name | DESOTO FAMILY CARE |
| Entity Type | Organization |
| Authorized Contact | DIOSAN MANGUBAT POWELL Msn 662-510-5353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 901872) |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2023-03-10 |