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General NPI Number Information
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NPI Number | 1437826633
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Entity Type | Individual
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Provider Name | GORDON ANDREW BALD
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Gender | Male
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 42 E CRESCENTVILLE RD
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City | CINCINNATI
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State | OH
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Zip | 45246-1302
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Country | US
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Telephone | 701-858-1801
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Fax | 513-671-7110
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Provider Business Mailing Address
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Address Line | 65 BOBTAIL WAY
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City | MONROE
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State | OH
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Zip | 45050-2439
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Country | US
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Telephone | 513-292-1647
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN388339
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License Number State | OH
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