Healthcare Provider Details

I. General information

NPI: 1568653632
Provider Name (Legal Business Name): GYNECOLOGIC ONCOLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MIAMI AVE SUITE 308
MIAMI FL
33133-4236
US

IV. Provider business mailing address

1613 NW 136TH AVE SUITE #200
SUNRISE FL
33323-2853
US

V. Phone/Fax

Practice location:
  • Phone: 954-838-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: LEWIS GOLD
Title or Position: PRESIDENT
Credential: MD
Phone: 954-838-2371