=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972308468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION HEALTH CARE FL PA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2025
-----------------------------------------------------
Last Update Date | 02/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 SW 27TH AVE STE 609
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-2968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-424-8622
-----------------------------------------------------
Fax | 305-394-9558
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1990 W 56TH ST APT 1310
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-6969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-448-3074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PIERRE S GORDON
-----------------------------------------------------
Credential | MEDICAL DOCTOR
-----------------------------------------------------
Telephone | 516-448-3074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------