Provider Demographics
NPI:1417343690
Name:PHYSICIAN ASSOCIATES MEDICAL GROUP, INC
Entity type:Organization
Organization Name:PHYSICIAN ASSOCIATES MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:TARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-813-4996
Mailing Address - Street 1:9950 RESEARCH DR STE A
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4309
Mailing Address - Country:US
Mailing Address - Phone:714-313-1493
Mailing Address - Fax:949-666-6636
Practice Address - Street 1:9950 RESEARCH DR STE A
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4309
Practice Address - Country:US
Practice Address - Phone:714-313-1493
Practice Address - Fax:949-666-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X, 207QG0300X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center