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General NPI Number Information
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NPI Number | 1780887760
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Entity Type | Organization
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Legal Business Name | TAMARAC PHYSICIANS GROUP INC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 8287 NW 88TH AVE
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City | TAMARAC
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State | FL
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Zip | 33321-1541
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Country | US
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Telephone | 954-722-6637
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Fax | 954-720-6298
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Provider Business Mailing Address
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Address Line | 8287 NW 88TH AVE
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City | TAMARAC
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State | FL
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Zip | 33321-1541
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Country | US
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Telephone | 954-722-6637
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Fax | 954-720-6298
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD FELDMAN
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Credential | D.C.
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Telephone | 954-722-6637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | ME93323
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME93323
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH3988
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License Number State | FL
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