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General NPI Number Information
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NPI Number | 1629185228
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Entity Type | Individual
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Provider Name | GORDON ANDREW MACBETH M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 414 G ST STE 221
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City | MARYSVILLE
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State | CA
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Zip | 95901-5670
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Country | US
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Telephone | 530-749-6650
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Fax | 530-749-6653
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Provider Business Mailing Address
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Address Line | 414 G ST STE 221
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City | MARYSVILLE
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State | CA
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Zip | 95901-5670
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Country | US
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Telephone | 530-749-6650
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Fax | 530-749-6653
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | G59779
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License Number State | CA
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