Provider Demographics
NPI:1215206438
Name:GURBACHAN PAL SONI M.D. PA.
Entity Type:Organization
Organization Name:GURBACHAN PAL SONI M.D. PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GURBACHAN
Authorized Official - Middle Name:PAL
Authorized Official - Last Name:SONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-458-5000
Mailing Address - Street 1:7301 PEPPERTREE CIR S
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-6922
Mailing Address - Country:US
Mailing Address - Phone:954-458-5000
Mailing Address - Fax:954-583-1664
Practice Address - Street 1:110 N FEDERAL HWY
Practice Address - Street 2:SUITE#302
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4300
Practice Address - Country:US
Practice Address - Phone:954-458-5000
Practice Address - Fax:954-583-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039003800Medicaid