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General NPI Number Information
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NPI Number | 1801001201
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Entity Type | Organization
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Legal Business Name | MID CAROLINA SURGICAL CLINIC PA
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 709B WICKER ST
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City | SANFORD
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State | NC
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Zip | 27330-4142
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Country | US
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Telephone | 919-775-3321
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Fax | 919-774-6974
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Provider Business Mailing Address
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Address Line | 709B WICKER ST
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City | SANFORD
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State | NC
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Zip | 27330-4142
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Country | US
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Telephone | 919-775-3321
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Fax | 919-774-6974
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL A GORDON
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Credential | M.D.
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Telephone | 919-775-3321
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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 | 13991
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License Number State | NC
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