1538268453 NPI number — SOFIA GOFMAN M.D.

Table of content: SOFIA GOFMAN M.D. (NPI 1538268453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538268453 NPI number — SOFIA GOFMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOFMAN
Provider First Name:
SOFIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538268453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 S PINE ISLAND RD STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33324-3923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-682-9877
Provider Business Mailing Address Fax Number:
305-682-1602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21097 NE 27TH CT STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-682-9877
Provider Business Practice Location Address Fax Number:
305-682-1602
Provider Enumeration Date:
09/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  35.132408 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME140965 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104049200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".