Provider Demographics
NPI:1326351511
Name:GORDON G SOUAID MD P L
Entity Type:Organization
Organization Name:GORDON G SOUAID MD P L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SOUAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-458-1170
Mailing Address - Street 1:406 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2999 NE 191ST ST
Practice Address - Street 2:SUITE 330
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3123
Practice Address - Country:US
Practice Address - Phone:305-933-3170
Practice Address - Fax:954-456-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44324207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046223300Medicaid
AS2679465OtherDEA REGISTRATION
AS2679465OtherDEA REGISTRATION
96469Medicare PIN