Healthcare Provider Details

I. General information

NPI: 1558606046
Provider Name (Legal Business Name): PCP OF MOBILE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OAKLAND PARK BLVD SUITE E 214
SUNRISE FL
33351-6741
US

IV. Provider business mailing address

7800 W OAKLAND PARK BLVD SUITE E 214
SUNRISE FL
33351-6741
US

V. Phone/Fax

Practice location:
  • Phone: 954-315-6590
  • Fax: 954-315-6604
Mailing address:
  • Phone: 954-315-6590
  • Fax: 954-315-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY P DUD
Title or Position: COO
Credential:
Phone: 954-318-6590