Provider Demographics
NPI:1396791323
Name:GM MEDICAL OFFICE INC
Entity type:Organization
Organization Name:GM MEDICAL OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN MONDRAGON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-554-5144
Mailing Address - Street 1:10760 W FLAGLER ST
Mailing Address - Street 2:STE 11
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4404
Mailing Address - Country:US
Mailing Address - Phone:305-554-5144
Mailing Address - Fax:305-554-5177
Practice Address - Street 1:10760 W FLAGLER ST
Practice Address - Street 2:STE 11
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4404
Practice Address - Country:US
Practice Address - Phone:305-554-5144
Practice Address - Fax:305-554-5177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty