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General NPI Number Information
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NPI Number | 1790739100
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE PRACTITIONERS AND ASSOCIATES
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 102 NE 2ND AVE
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4212
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Country | US
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Telephone | 954-894-0522
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Fax | 954-964-1244
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Provider Business Mailing Address
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Address Line | 102 NE 2ND AVE
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4212
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Country | US
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Telephone | 954-894-0522
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Fax | 954-964-1244
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Authorized Official
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Title or Position | OWNER
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Name | MR. IVORY JOE CHRISTEN
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Credential | ARNP
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Telephone | 954-894-0522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | FL
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