| Entity Name: | PGL MEDICAL GROUP, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Mar 2011 (14 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | P11000027131 |
| FEI/EIN Number | 450821009 |
| Address: | 108 Intracoastal Pointe Drive, Suite 300, Jupiter, FL, 33477, US |
| Mail Address: | 108 Intracoastal Pointe Drive, Suite 300, Jupiter, FL, 33477, US |
| ZIP code: | 33477 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518220565 | 2012-06-24 | 2012-06-24 | 108 INTRACOASTAL POINTE DR, SUITE 100, JUPITER, FL, 334775036, US | 108 INTRACOASTAL POINTE DR, SUITE 100, JUPITER, FL, 334775036, US | |||||||||||||||||||
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| Phone | +1 561-575-3050 |
| Fax | 5615753153 |
Authorized person
| Name | DR. GLENDESE C MILLER |
| Role | VICE PRESIDENT |
| Phone | 5617977653 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME104698 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LYN PETER O | Agent | 112 CASA GRANDE CT, PALM BEACH GARDENS, FL, 33418 |
| Name | Role | Address |
|---|---|---|
| LYN PETER O | President | 112 CASA GRANDE CT, PALM BEACH GARDENS, FL, 33418 |
| Name | Role | Address |
|---|---|---|
| MILLER GLENDESE C | Vice President | 112 CASA GRANDE CT, PALM BEACH GARDENS, FL, 33418 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-12 | 108 Intracoastal Pointe Drive, Suite 300, Jupiter, FL 33477 | No data |
| CHANGE OF MAILING ADDRESS | 2014-01-12 | 108 Intracoastal Pointe Drive, Suite 300, Jupiter, FL 33477 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-01-12 |
| ANNUAL REPORT | 2013-01-17 |
| ANNUAL REPORT | 2012-01-13 |
| Domestic Profit | 2011-03-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
