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General NPI Number Information
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NPI Number | 1316938038
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Entity Type | Individual
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Provider Name | GORDON ALAN BEARDWOOD MD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 715 S 8TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-7530
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Country | US
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Telephone | 612-873-6963
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Fax |
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Provider Business Mailing Address
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Address Line | 701 PARK AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1623
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Country | US
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Telephone | 612-873-3000
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 60395
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 60395
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License Number State | MN
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