Regenerative Medical Group | |
1400 Se Goldtree Dr Ste 207 Port Saint Lucie FL 34952-7582 | |
(772) 777-2836 | |
Not Available |
Full Name | Regenerative Medical Group |
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Speciality | Family Medicine |
Location | 1400 Se Goldtree Dr, Port Saint Lucie, Florida |
Authorized Official Name and Position | Bryn J Henderson (CEO) |
Authorized Official Contact | 7149818058 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Regenerative Medical Group 600 E Chapman Ave Orange CA 92866-1605 Ph: (714) 639-4012 | Regenerative Medical Group 1400 Se Goldtree Dr Ste 207 Port Saint Lucie FL 34952-7582 Ph: (772) 777-2836 |
NPI Number | 1578928867 |
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Provider Enumeration Date | 12/31/2015 |
Last Update Date | 12/31/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578928867 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 035817 (California) | Primary |
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