Healthcare Provider Details

I. General information

NPI: 1780887760
Provider Name (Legal Business Name): TAMARAC PHYSICIANS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8287 NW 88TH AVE
TAMARAC FL
33321-1541
US

IV. Provider business mailing address

8287 NW 88TH AVE
TAMARAC FL
33321-1541
US

V. Phone/Fax

Practice location:
  • Phone: 954-722-6637
  • Fax: 954-720-6298
Mailing address:
  • Phone: 954-722-6637
  • Fax: 954-720-6298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH3988
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberME93323
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME93323
License Number StateFL

VIII. Authorized Official

Name: RONALD FELDMAN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 954-722-6637