Healthcare Provider Details

I. General information

NPI: 1336321330
Provider Name (Legal Business Name): DAVID JON GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR DEPARTMENT OF PEDIATRIC HEMATOLOGY/ONCOLOGY
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR DEPT OF PEDIATRIC HEMATOLOGY/ONCOLOGY
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-384-5108
  • Fax:
Mailing address:
  • Phone: 319-384-5108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD-41743
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: