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NPI Code Detail

MEDICARE: DR. GORDON OLIVER DOWNEY M.D.

MEDICARE: DR. GORDON OLIVER DOWNEY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VX0201XGynecologic Oncology PhysicianGD059209MI
2207VX0201XGynecologic Oncology Physician4301059209MI

General Provider Information

NPI Number : 1053421024
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GORDON OLIVER DOWNEY M.D.
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 145 MICHIGAN ST NE
Second Line : SUITE 6300
City : GRAND RAPIDS
State : MI
Zip : 49503-2562
Country : US
Telephone Number : 616-486-6000
Fax Number : 616-486-2065
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 06/11/2015

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