| NPI | 1992722482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE T BREWER Director Of Provider Enrollment 877-892-9813 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 207RG0100X Internal Medicine, Gastroenterology | |
| 208000000X Pediatrics | |
| 208600000X Surgery | |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-06-09 |