| NPI | 1972931533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN BROXTON CLARK Physician 251-295-2579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AL 23993) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL 143) |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2013-10-17 |