Provider Demographics
NPI:1740234988
Name:SOUAID, GORDON GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:GEORGE
Last Name:SOUAID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4611
Mailing Address - Country:US
Mailing Address - Phone:305-933-3170
Mailing Address - Fax:954-456-5019
Practice Address - Street 1:1740 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4611
Practice Address - Country:US
Practice Address - Phone:305-933-3170
Practice Address - Fax:954-456-5019
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44324207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046223300Medicaid
FL592616521OtherEIN TAX ID NUMBER
FL592616521OtherEIN TAX ID NUMBER
FLD78994Medicare UPIN