MEDICARE: GORDON K KANZER 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
1	2085R0202X	Diagnostic Radiology Physician	74817	MA

General Provider Information

NPI Number	:	1417915380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON K KANZER M.D.

Provider Business Mailing Address
First Line	:	420 LIBBEY INDUSTRIAL PKWY
Second Line	:
City	:	WEYMOUTH
State	:	MA
Zip	:	02189-3134
Country	:	US
Telephone Number	:	781-331-9880
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 CEDARHILL PARK DR
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2226
Country	:	US
Telephone Number	:	508-888-2270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	09/08/2009

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