Provider Demographics
NPI:1780887760
Name:TAMARAC PHYSICIANS GROUP INC
Entity type:Organization
Organization Name:TAMARAC PHYSICIANS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-722-6637
Mailing Address - Street 1:8287 NW 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1541
Mailing Address - Country:US
Mailing Address - Phone:954-722-6637
Mailing Address - Fax:954-720-6298
Practice Address - Street 1:8287 NW 88TH AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1541
Practice Address - Country:US
Practice Address - Phone:954-722-6637
Practice Address - Fax:954-720-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93323204C00000X, 207R00000X
FLCH3988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380109800Medicaid
FL88904ZMedicare ID - Type Unspecified
FL29533ZMedicare ID - Type Unspecified
FLT56015Medicare UPIN
FL380109800Medicaid