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General NPI Number Information
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NPI Number | 1003734716
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Entity Type | Individual
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Provider Name | RANDALL SCOTT GORDON SR.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 3161 FORESTMEADOW DR
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44223-2853
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Country | US
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Telephone | 330-472-8474
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Fax |
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Provider Business Mailing Address
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Address Line | 3730 BAIRD RD
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City | STOW
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State | OH
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Zip | 44224-4204
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Country | US
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Telephone | 330-322-5146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | RJ712817
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License Number State | OH
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