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NPI Code Detail

MEDICARE: GORDON C DAVIS MEDICAL PC

MEDICARE: GORDON C DAVIS MEDICAL PC
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
1261QH0100XHealth Service Clinic/Center

General Provider Information

NPI Number : 1568644334
Entity Type Code : Organization
Provider Name (Legal Business Name) : GORDON C DAVIS MEDICAL PC
Provider Business Mailing Address
First Line : 1611 E NEW YORK AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-6860
Country : US
Telephone Number : 178-566-0022
Fax Number :
Provider Business Practice Location Address
First Line : 1611 E NEW YORK AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11212-6860
Country : US
Telephone Number : 718-566-0022
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : GORDON C DAVIS
Credential : DO
Telephone Number : 718-566-0022
Provider Enumeration Date : 12/03/2007
Last Update Date : 12/03/2007

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