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Physicians Emergency Medicine

Provider NPI: 1174560304

Organization Information:
Organization is not Subpart
Authorized Official:  EUGENE C. WALLACE  CEO  508-941-7062

Practice Location:
680 CENTRE ST  BROCKTON, MA 02302-3308 US
Tel: 508-941-7062  Fax: 508-941-6337

Business Mailing Address:
PO BOX 847493  BOSTON, MA 02284-7493 US
Tel: 508-565-0147  Fax: 508-565-0157

NPI Information:
NPI: 1174560304
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Emergency Medicine
Obstetrics & Gynecology
Psychiatry & Neurology
Internal Medicine
Internal Medicine
Internal Medicine
Internal Medicine
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
Internal Medicine
Orthopaedic Surgery
Internal Medicine

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207R00000X





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