Provider Demographics
NPI:1750358123
Name:GORMAN, BARUCH DAVID (MD)
Entity type:Individual
Prefix:
First Name:BARUCH
Middle Name:DAVID
Last Name:GORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:BARUCH
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10075 S JOG RD STE 203
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3536
Mailing Address - Country:US
Mailing Address - Phone:561-767-9999
Mailing Address - Fax:855-699-3535
Practice Address - Street 1:10075 S JOG RD STE 203
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3536
Practice Address - Country:US
Practice Address - Phone:561-767-9999
Practice Address - Fax:855-699-3535
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121117207W00000X
FLME155444207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00385039Medicaid
NYB00069Medicare UPIN
NY00385039Medicaid