Healthcare Provider Details

I. General information

NPI: 1326054263
Provider Name (Legal Business Name): GORDON ALEXANDER HASKELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 E FAIR ST BLOOMBURG HOSPITAL
BLOOMSBURG PA
17815
US

IV. Provider business mailing address

3141 NW 63RD SUITE 4
OKLAHOMA CITY OK
73116
US

V. Phone/Fax

Practice location:
  • Phone: 717-387-2115
  • Fax:
Mailing address:
  • Phone: 405-607-1318
  • Fax: 405-607-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD37149E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: