MEDICARE: DR. HORATIO GORDON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	230708	NY
2	208600000X	Surgery Physician	ME 126024	FL
3	261QP2300X	Primary Care Clinic/Center	ME126024	FL

General Provider Information

NPI Number	:	1376957720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HORATIO GORDON M.D.

Provider Business Mailing Address
First Line	:	11900 BISCAYNE BLVD STE 266
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2756
Country	:	US
Telephone Number	:	954-368-7644
Fax Number	:	786-360-2578

Provider Business Practice Location Address
First Line	:	11900 BISCAYNE BLVD STE 266
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2756
Country	:	US
Telephone Number	:	954-368-7644
Fax Number	:	786-360-2578

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	05/25/2026

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