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General NPI Number Information
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NPI Number | 1518145226
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Entity Type | Organization
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Legal Business Name | GORDON BASKIN, MD PA
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 1050 SE MONTEREY RD SUITE 204
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City | STUART
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State | FL
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Zip | 34994-4512
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Country | US
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Telephone | 772-781-5960
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Fax | 772-419-0190
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Provider Business Mailing Address
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Address Line | 1050 SE MONTEREY RD SUITE 204
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City | STUART
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State | FL
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Zip | 34994-4512
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Country | US
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Telephone | 772-781-5960
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Fax | 772-419-0190
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON SAINT CLAIR BASKIN
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Credential | M.D.
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Telephone | 772-781-5960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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