Organization Name: | PHYSICIAN MED-CARE PROVIDERS CORP |
NPI Number: | 1114195427 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GARY ROBERTSON (PRESIDENT) |
Mailing Address: | 6175 Nw 153rd St #301 Miami Lakes |
State: | FL US |
Postal Code: | 330142435 |
Phone Number: | 3055589522 |
Fax Number: | 3055589520 |
NPI Enumeration Date: | 02/20/2008 |
NPI Last Update Date: | 02/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |