Healthcare Provider Details

I. General information

NPI: 1083088579
Provider Name (Legal Business Name): PALMERS URGENT CARE AND DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 N STATE ROAD 7
TAMARAC FL
33319-2921
US

IV. Provider business mailing address

5409 N STATE ROAD 7
TAMARAC FL
33319-2921
US

V. Phone/Fax

Practice location:
  • Phone: 954-526-9477
  • Fax:
Mailing address:
  • Phone: 954-526-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME 79727
License Number StateFL

VIII. Authorized Official

Name: JEAN ROBERT CHARLOT
Title or Position: OWNER
Credential: M.D
Phone: 954-526-9477