Healthcare Provider Details

I. General information

NPI: 1043460389
Provider Name (Legal Business Name): PHYSICIANS TO CHILDREN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 GRANELLO AVE
CORAL GABLES FL
33146-1806
US

IV. Provider business mailing address

305 GRANELLO AVE
CORAL GABLES FL
33146-1806
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-2546
  • Fax: 305-448-0219
Mailing address:
  • Phone: 305-446-2546
  • Fax: 305-448-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME56925
License Number StateFL

VIII. Authorized Official

Name: DR. PHILLIP GARY NEWCOMM JR.
Title or Position: PARTNER
Credential: M.D.
Phone: 305-446-2546