Provider Demographics
NPI:1457841017
Name:PRIMARY CARE PHYSICIANS OF HOLLYWOOD, PA
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIANS OF HOLLYWOOD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-399-9014
Mailing Address - Street 1:7050 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3804
Mailing Address - Country:US
Mailing Address - Phone:954-399-9014
Mailing Address - Fax:954-983-1152
Practice Address - Street 1:6517 TAFT ST STE 101
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4063
Practice Address - Country:US
Practice Address - Phone:954-983-9191
Practice Address - Fax:954-983-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty