Provider Demographics
NPI:1376957720
Name:GORDON, HORATIO (MD)
Entity Type:Individual
Prefix:DR
First Name:HORATIO
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HORATIO
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11900 BISCAYNE BLVD STE 266
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2756
Mailing Address - Country:US
Mailing Address - Phone:954-368-7644
Mailing Address - Fax:786-360-2578
Practice Address - Street 1:11900 BISCAYNE BLVD STE 266
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2756
Practice Address - Country:US
Practice Address - Phone:954-368-7644
Practice Address - Fax:786-360-2578
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 126024208600000X
NY230708208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery