Healthcare Provider Details

I. General information

NPI: 1114929114
Provider Name (Legal Business Name): MICHAEL S GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 E DEL CAMINO DR SUITE 100
SCOTTSDALE AZ
85258-2351
US

IV. Provider business mailing address

9055 E DEL CAMINO DR SUITE 100
SCOTTSDALE AZ
85258-2351
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-5000
  • Fax: 480-314-0033
Mailing address:
  • Phone: 480-860-5000
  • Fax: 480-314-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number28246
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: