Healthcare Provider Details

I. General information

NPI: 1124939608
Provider Name (Legal Business Name): GIDEON RISK MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 S OCEAN BLVD
LANTANA FL
33462-6211
US

IV. Provider business mailing address

19790 W DIXIE HWY STE 603
MIAMI FL
33180-2295
US

V. Phone/Fax

Practice location:
  • Phone: 561-851-5665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARSON HENDERSON
Title or Position: PA-C
Credential: PA-C
Phone: 561-420-9247