Provider Demographics
NPI:1740502228
Name:CLEOPATRA GORDON PUSEY, MD P.A.
Entity type:Organization
Organization Name:CLEOPATRA GORDON PUSEY, MD P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEOPATRA
Authorized Official - Middle Name:TAMARIA
Authorized Official - Last Name:GORDON PUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-392-9026
Mailing Address - Street 1:222 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1721
Mailing Address - Country:US
Mailing Address - Phone:954-392-9026
Mailing Address - Fax:954-357-2353
Practice Address - Street 1:700 N HIATUS RD
Practice Address - Street 2:SUITE 213
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5206
Practice Address - Country:US
Practice Address - Phone:954-392-9026
Practice Address - Fax:954-357-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL146LMOtherBCBS
FL281390401Medicaid
FL281390402Medicaid
FL281390400Medicaid
FL311776OtherAVMED
FLDC471AMedicare PIN
FL281390400Medicaid