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General NPI Number Information
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NPI Number | 1114221223
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Entity Type | Organization
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Legal Business Name | MICHAEL H GORDON MD PA
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 2001 NE 48TH CT
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4512
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Country | US
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Telephone | 954-772-0115
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Fax | 954-772-1216
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Provider Business Mailing Address
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Address Line | 2001 NE 48TH CT
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4512
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Country | US
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Telephone | 954-772-0115
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL H GORDON
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Credential | M.D.
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Telephone | 954-772-0115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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