Provider Demographics
NPI:1881877579
Name:BOB M GAJRAJ MD PA
Entity type:Organization
Organization Name:BOB M GAJRAJ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:GAJRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-812-1000
Mailing Address - Street 1:10000 W.SAMPLE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:754-812-1000
Mailing Address - Fax:954-775-0661
Practice Address - Street 1:4966 N. PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:954-345-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063237600Medicaid