Healthcare Provider Details

I. General information

NPI: 1770959611
Provider Name (Legal Business Name): MCLINICIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 NW 13TH AVE
POMPANO BEACH FL
33064-8650
US

IV. Provider business mailing address

118 CARRS TRL
GREENE RI
02827-1808
US

V. Phone/Fax

Practice location:
  • Phone: 855-883-6286
  • Fax: 855-883-6286
Mailing address:
  • Phone: 855-883-6286
  • Fax: 855-883-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID C HUGHES
Title or Position: CEO & PRESIDENT
Credential: PHARMD
Phone: 401-481-3001