Provider Demographics
NPI:1811097215
Name:SONI, GURBACHAN PAL (MD)
Entity type:Individual
Prefix:DR
First Name:GURBACHAN
Middle Name:PAL
Last Name:SONI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7301 PEPPERTREE CIR S
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-6922
Mailing Address - Country:US
Mailing Address - Phone:954-458-5000
Mailing Address - Fax:954-583-1664
Practice Address - Street 1:110 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:SUITE#302
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-458-5000
Practice Address - Fax:954-583-1664
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0034790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD13859Medicare UPIN