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General NPI Number Information
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NPI Number | 1043954472
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Entity Type | Individual
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Provider Name | NICANDA NORRIE GORDON MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 237 GEORGE BUSH BLVD
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City | DELRAY BEACH
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State | FL
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Zip | 33444-4034
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Country | US
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Telephone | 561-272-5373
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Fax | 833-625-1627
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Provider Business Mailing Address
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Address Line | 1001 NW 13TH ST STE 201
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City | BOCA RATON
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State | FL
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Zip | 33486-2269
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Country | US
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Telephone | 561-955-6663
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Fax | 561-955-2897
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME171445
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License Number State | FL
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