Provider Demographics
NPI:1760408843
Name:G DAVID ONSTAD MD PA
Entity Type:Organization
Organization Name:G DAVID ONSTAD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ONSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-491-9010
Mailing Address - Street 1:1960 NE 47 STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-491-9010
Mailing Address - Fax:954-491-1009
Practice Address - Street 1:1960 NE 47 STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-491-9010
Practice Address - Fax:954-491-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty