Healthcare Provider Details

I. General information

NPI: 1902992225
Provider Name (Legal Business Name): GORDON FOOT CARE,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W 41ST ST SUITE #218
MIAMI BEACH FL
33140-3641
US

IV. Provider business mailing address

333 W 41ST ST SUITE #218
MIAMI BEACH FL
33140-3641
US

V. Phone/Fax

Practice location:
  • Phone: 305-532-5630
  • Fax: 305-532-2530
Mailing address:
  • Phone: 305-532-5630
  • Fax: 305-532-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2890
License Number StateFL

VIII. Authorized Official

Name: DR. ANDREW GORDON
Title or Position: OWNER
Credential: DPM
Phone: 305-532-5630