Provider Demographics
NPI:1114195427
Name:PHYSICIAN MED-CARE PROVIDERS CORP
Entity Type:Organization
Organization Name:PHYSICIAN MED-CARE PROVIDERS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-558-9522
Mailing Address - Street 1:6175 NW 153RD ST
Mailing Address - Street 2:#301
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2435
Mailing Address - Country:US
Mailing Address - Phone:305-558-9522
Mailing Address - Fax:305-558-9520
Practice Address - Street 1:6175 NW 153RD ST
Practice Address - Street 2:#301
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2435
Practice Address - Country:US
Practice Address - Phone:305-558-9522
Practice Address - Fax:305-558-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty