Healthcare Provider Details

I. General information

NPI: 1154917706
Provider Name (Legal Business Name): LORDS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 09/13/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 SW 3RD AVE
POMPANO BEACH FL
33060-8384
US

IV. Provider business mailing address

661 SW 3RD AVE
POMPANO BEACH FL
33060-8384
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-3685
  • Fax: 954-771-3685
Mailing address:
  • Phone: 954-771-3685
  • Fax: 954-771-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY ALLEN MIDDLETON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 954-771-3685