Provider Demographics
NPI:1184264764
Name:GAMME, GIRMA MOGES (MD)
Entity type:Individual
Prefix:MR
First Name:GIRMA
Middle Name:MOGES
Last Name:GAMME
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 1:1120 NW 14TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DON SOFFER CLINICAL RESEARCH BUILDING
Practice Address - Street 2:1120 NW 14TH STREET - 4TH FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:631-686-7679
Practice Address - Fax:631-686-6925
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2023-01-06
Deactivation Date:2020-12-08
Deactivation Code:
Reactivation Date:2022-11-07
Provider Licenses
StateLicense IDTaxonomies
NY302170208600000X
FLME159498208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY302170Medicaid