Healthcare Provider Details

I. General information

NPI: 1861740672
Provider Name (Legal Business Name): GALAL ELGAZZAZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GALAL SOLIMAN ELGAZZAZ PHD

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S ANDREWS AVE FL 3
FT LAUDERDALE FL
33316-2509
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-320-3304
  • Fax: 954-320-3318
Mailing address:
  • Phone: 954-320-3304
  • Fax: 954-320-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberME126586
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME126586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: