Provider Demographics
NPI:1508032681
Name:GAYNAIR FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:GAYNAIR FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANEITA
Authorized Official - Last Name:GAYNAIR-SURRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MSC
Authorized Official - Phone:216-496-5938
Mailing Address - Street 1:3330 SPANISH MOSS TER
Mailing Address - Street 2:109
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5058
Mailing Address - Country:US
Mailing Address - Phone:216-496-5938
Mailing Address - Fax:954-530-3138
Practice Address - Street 1:3330 SPANISH MOSS TER
Practice Address - Street 2:109
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-5058
Practice Address - Country:US
Practice Address - Phone:216-496-5938
Practice Address - Fax:954-530-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94856261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006618500Medicaid
FL281403000Medicaid
FL281403000Medicaid
FL006618500Medicaid