Provider Demographics
NPI:1972947117
Name:PRIMARY CARE PHYSICINS OF HOLLYWOOD PA
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICINS OF HOLLYWOOD PA
Other - Org Name:PCP RX DIRECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-983-9191
Mailing Address - Street 1:6517 TAFT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4008
Mailing Address - Country:US
Mailing Address - Phone:954-983-9191
Mailing Address - Fax:954-983-1152
Practice Address - Street 1:6517 TAFT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4008
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:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty