Provider Demographics
NPI:1831274794
Name:GORDON, ANDREW (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W 41ST ST
Mailing Address - Street 2:SUITE #218
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3641
Mailing Address - Country:US
Mailing Address - Phone:305-532-5630
Mailing Address - Fax:305-532-2530
Practice Address - Street 1:333 W 41ST ST
Practice Address - Street 2:SUITE #218
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3641
Practice Address - Country:US
Practice Address - Phone:305-532-5630
Practice Address - Fax:305-532-2530
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2890213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340493500Medicaid
FL5560820001Medicare NSC
FLU82916Medicare UPIN
FLE4918Medicare ID - Type UnspecifiedSENDER #