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1316156854 NPI number — MIGUEL ANGEL GORDILLO D.P.M.

NPI Number: 1316156854
Health Care Provider/Practitioner: MIGUEL ANGEL GORDILLO D.P.M.

Information about “1316156854” NPI (MIGUEL ANGEL GORDILLO D.P.M.) exists in 1316156854 in HTML format HTML  |  1316156854 in plain Text format TXT  |  1316156854 in PDF (Portable Document Format) PDF  |  1316156854 in an XML format XML  formats.

NPI Number : 1316156854 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316156854",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GORDILLO",
    "FirstName": "MIGUEL",
    "MiddleName": "ANGEL",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.P.M.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5050 NW 7TH ST",
    "SecondLineMailingAddress": "SUITE 203",
    "MailingAddressCityName": "MIAMI",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33126-3441",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "305-443-8301",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "613 E 49TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HIALEAH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33013-1963",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-828-2288",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/22/2007",
    "LastUpdateDate": "03/25/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "213E00000X",
        "TaxonomyName": "Podiatrist",
        "LicenseNumber": "PO2954",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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