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General NPI Number Information
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NPI Number | 1467441618
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Entity Type | Individual
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Provider Name | MARK WILLIAM GORDON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 7100 W 20TH AVE #703
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City | HIALEAH
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State | FL
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Zip | 33016-1897
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Country | US
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Telephone | 305-822-4515
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Fax | 954-963-3453
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Provider Business Mailing Address
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Address Line | 2301 N UNIVERSITY DR #203
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-3617
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Country | US
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Telephone | 954-964-1490
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Fax | 954-963-3453
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME13633
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License Number State | FL
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