Provider Demographics
NPI:1821275462
Name:GORDON-PUSEY, CLEOPATRA T (MD)
Entity Type:Individual
Prefix:MRS
First Name:CLEOPATRA
Middle Name:T
Last Name:GORDON-PUSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CLEOPATRA
Other - Middle Name:T
Other - Last Name:GORDON-PUSEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 260816
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-7816
Mailing Address - Country:US
Mailing Address - Phone:954-392-9026
Mailing Address - Fax:954-357-2353
Practice Address - Street 1:222 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1721
Practice Address - Country:US
Practice Address - Phone:954-392-9026
Practice Address - Fax:954-357-2353
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111851800Medicaid
FL101833801Medicaid
FL146LMOtherBCBS
FL101833800Medicaid
FL281390401Medicaid