Provider Demographics
NPI:1356506877
Name:PHYSICIANS CLINICAL RESEARCH ALLIANCE, LLC.
Entity Type:Organization
Organization Name:PHYSICIANS CLINICAL RESEARCH ALLIANCE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-656-8855
Mailing Address - Street 1:2825 N STATE ROAD 7
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5737
Mailing Address - Country:US
Mailing Address - Phone:954-935-1477
Mailing Address - Fax:954-935-1422
Practice Address - Street 1:2825 N STATE ROAD 7
Practice Address - Street 2:SUITE 204
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5737
Practice Address - Country:US
Practice Address - Phone:954-935-1477
Practice Address - Fax:954-935-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
40029OtherMEDICRE PTAN