MEDICARE: GALAL ELGAZZAZ M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204F00000X	Transplant Surgery Physician	ME126586	FL
2	208600000X	Surgery Physician	ME126586	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861740672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALAL ELGAZZAZ M.D

Provider Business Mailing Address
First Line	:	1608 SE 3RD AVE FL 3
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2564
Country	:	US
Telephone Number	:	954-320-3304
Fax Number	:	954-320-3318

Provider Business Practice Location Address
First Line	:	1601 S ANDREWS AVE FL 3
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2509
Country	:	US
Telephone Number	:	954-320-3304
Fax Number	:	954-320-3318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	02/11/2025

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