Healthcare Provider Details

I. General information

NPI: 1518361237
Provider Name (Legal Business Name): JOSEPH GORDON DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 OBERLIN RD
RALEIGH NC
27608-2018
US

IV. Provider business mailing address

1216 OBERLIN RD
RALEIGH NC
27608-2018
US

V. Phone/Fax

Practice location:
  • Phone: 919-832-3107
  • Fax: 919-834-4045
Mailing address:
  • Phone: 919-832-3107
  • Fax: 919-834-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number2317
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: