MEDICARE: DR. ANDREW GORDON DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	PO2890	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831274794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW GORDON DPM

Provider Business Mailing Address
First Line	:	333 W 41ST ST
Second Line	:	SUITE #218
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3641
Country	:	US
Telephone Number	:	305-532-5630
Fax Number	:	305-532-2530

Provider Business Practice Location Address
First Line	:	333 W 41ST ST
Second Line	:	SUITE #218
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3641
Country	:	US
Telephone Number	:	305-532-5630
Fax Number	:	305-532-2530

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	10/07/2014

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