Healthcare Provider Details

I. General information

NPI: 1841948403
Provider Name (Legal Business Name): PHR MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 US 1
LAKE PARK FL
33403-3557
US

IV. Provider business mailing address

741 US HIGHWAY 1 STE B
NORTH PALM BEACH FL
33408-4508
US

V. Phone/Fax

Practice location:
  • Phone: 561-704-6781
  • Fax:
Mailing address:
  • Phone: 561-704-6781
  • Fax: 561-209-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RANDY HERFIELD
Title or Position: CEO
Credential:
Phone: 561-704-6781