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Individual

ALEXANDER M GORUP

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1601 CLINT MOORE RD STE 105, BOCA RATON, FL 33487-5712
(561) 391-3333
(561) 391-5618
Mailing address
1601 CLINT MOORE RD STE 215, BOCA RATON, FL 33487-5716
(561) 939-0193
(561) 338-6271

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01058318A
IN
207Y00000X
Otolaryngology Physician
Primary
ME112703
FL
207YS0123X
Facial Plastic Surgery Physician
01058318A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000312445
ANTHEM PROVIDER NUMBER
IN
05
200459890
IN
Enumeration date
03/16/2006
Last updated
01/24/2022
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