Healthcare Provider Details

I. General information

NPI: 1255388500
Provider Name (Legal Business Name): JAMES D. GORDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 W SAINT MARYS RD SUITE 211
TUCSON AZ
85745-2696
US

IV. Provider business mailing address

1775 W SAINT MARYS RD SUITE 211
TUCSON AZ
85745-2696
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-2170
  • Fax: 520-792-9702
Mailing address:
  • Phone: 520-792-2170
  • Fax: 520-792-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number28386
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number28386
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number28386
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28386
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: