Provider Demographics
NPI:1861740672
Name:ELGAZZAZ, GALAL (MD)
Entity type:Individual
Prefix:
First Name:GALAL
Middle Name:
Last Name:ELGAZZAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GALAL
Other - Middle Name:SOLIMAN
Other - Last Name:ELGAZZAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1608 SE 3RD AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2564
Mailing Address - Country:US
Mailing Address - Phone:954-320-3304
Mailing Address - Fax:954-320-3318
Practice Address - Street 1:1601 S ANDREWS AVE FL 3
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2509
Practice Address - Country:US
Practice Address - Phone:954-320-3304
Practice Address - Fax:954-320-3318
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126586204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017592500Medicaid
FLIP310ZMedicare PIN