Provider Demographics
NPI:1144468323
Name:GARY L CURSON PA
Entity type:Organization
Organization Name:GARY L CURSON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CURSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:305-865-2281
Mailing Address - Street 1:9528 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2502
Mailing Address - Country:US
Mailing Address - Phone:305-865-2281
Mailing Address - Fax:305-868-6824
Practice Address - Street 1:9528 HARDING AVENUE
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154
Practice Address - Country:US
Practice Address - Phone:305-865-2281
Practice Address - Fax:305-868-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1526332B00000X
FLPO1529213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029783600Medicaid
FL029783600Medicaid