Healthcare Provider Details

I. General information

NPI: 1508152521
Provider Name (Legal Business Name): MARGARET E GORDON DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2972 OLD OLYMPIC HWY
PORT ANGELES WA
98362-9121
US

IV. Provider business mailing address

2972 OLD OLYMPIC HWY
PORT ANGELES WA
98362-9121
US

V. Phone/Fax

Practice location:
  • Phone: 360-457-3842
  • Fax: 360-452-7430
Mailing address:
  • Phone: 360-457-3842
  • Fax: 360-452-7430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVT60095715
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: