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Organization

JEFFREY S GORODETSKY MD PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JEFFREY S GORODETSKY MD (PRESIDENT)
(772) 223-4504
Entity
Organization

Contact information

Practice address
433 E OCEAN BLVD, STUART, FL 34994-2573
(772) 223-4504
(772) 223-5988
Mailing address
433 E OCEAN BLVD, STUART, FL 34994-2573
(772) 223-4504
(772) 223-5988

Taxonomy

Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
ME0053894
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
048745701
FL
01
07463
BLUE CROSS BLUE SHIELD
FL
01
07463P
MEDICARE INDIVIDUAL
FL
01
K9632
MEDICACE GROUP
FL
01
P00307631
RAILROAD MEDICARE
FL
Enumeration date
10/17/2007
Last updated
09/17/2012
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