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General NPI Number Information
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NPI Number | 1083968523
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Entity Type | Individual
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Provider Name | JEFFERY DWIGHT GORDON MBA
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Gender | Male
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 7990 SW 117TH AVE STE 125
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City | MIAMI
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State | FL
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Zip | 33183-3845
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Country | US
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Telephone | 305-929-8705
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Fax |
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Provider Business Mailing Address
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Address Line | 7990 SW 117TH AVE STE 125
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City | MIAMI
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State | FL
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Zip | 33183-3845
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Country | US
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Telephone | 305-929-8705
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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