Provider Demographics
NPI:1902992225
Name:GORDON FOOT CARE,PA
Entity Type:Organization
Organization Name:GORDON FOOT CARE,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-532-5630
Mailing Address - Street 1:333 W 41ST ST
Mailing Address - Street 2:SUITE #218
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3641
Mailing Address - Country:US
Mailing Address - Phone:305-532-5630
Mailing Address - Fax:305-532-2530
Practice Address - Street 1:333 W 41ST ST
Practice Address - Street 2:SUITE #218
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3641
Practice Address - Country:US
Practice Address - Phone:305-532-5630
Practice Address - Fax:305-532-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2890213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340493500Medicaid
FLK7219Medicare PIN
FLY28997Medicare UPIN
FL5560820001Medicare NSC