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General NPI Number Information
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NPI Number | 1770586919
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Entity Type | Individual
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Provider Name | JEFFERY S GORDON MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 1300 SAWGRASS CORPORATE PARKWAY STE 200
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City | SUNRISE
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State | FL
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Zip | 33323-2823
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Country | US
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Telephone | 800-243-3839
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Fax | 855-527-5510
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Provider Business Mailing Address
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Address Line | 127 CRESTVIEW PARK DR
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City | DICKSON
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State | TN
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Zip | 37055-2855
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Country | US
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Telephone | 615-446-5121
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Fax | 615-446-1357
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD11542
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 11542
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License Number State | TN
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