Provider Demographics
NPI:1346414364
Name:HARRY F GORDON, MD, LLC
Entity Type:Organization
Organization Name:HARRY F GORDON, MD, LLC
Other - Org Name:FAMILY CARE OF SOUTHWEST ORLANDO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUCHI
Authorized Official - Middle Name:
Authorized Official - Last Name:AHLUWALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-274-0300
Mailing Address - Street 1:1601 PARK CENTER DR STE 345
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5700
Mailing Address - Country:US
Mailing Address - Phone:407-351-3673
Mailing Address - Fax:407-226-2898
Practice Address - Street 1:1601 PARK CENTER DR
Practice Address - Street 2:SUITES 3,4,5
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5700
Practice Address - Country:US
Practice Address - Phone:407-522-4555
Practice Address - Fax:407-226-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8876Medicare PIN