Provider Demographics
NPI:1275590622
Name:MCLAUGHLIN, GWENN E (MD)
Entity Type:Individual
Prefix:DR
First Name:GWENN
Middle Name:E
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 NW 12TH AVE
Mailing Address - Street 2:M851
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-243-4029
Mailing Address - Fax:305-243-8470
Practice Address - Street 1:1601 NW 12TH AVE
Practice Address - Street 2:M851
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-4029
Practice Address - Fax:305-243-8470
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME587072080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0512095-00Medicaid
FL11678Medicare ID - Type Unspecified
FLE70187Medicare UPIN