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General NPI Number Information
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NPI Number | 1568382992
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Entity Type | Individual
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Provider Name | MICHAEL L GORDER
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Gender | Male
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 7981 GEORGIA ST
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City | HILL AIR FORCE BASE
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State | UT
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Zip | 84056-5824
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Country | US
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Telephone | 801-777-7909
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Fax |
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Provider Business Mailing Address
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Address Line | 2389 W 1100 S
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City | SYRACUSE
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State | UT
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Zip | 84075-5003
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Country | US
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Telephone | 801-518-9391
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 271555-3102
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License Number State | UT
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