Healthcare Provider Details

I. General information

NPI: 1942598321
Provider Name (Legal Business Name): CHRISTOPHER GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N STATE ST
GREENFIELD IN
46140-1270
US

IV. Provider business mailing address

4139 ELKHORN WAY
WESTFIELD IN
46062-6539
US

V. Phone/Fax

Practice location:
  • Phone: 317-462-5544
  • Fax:
Mailing address:
  • Phone: 317-506-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01073685A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: