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General NPI Number Information
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NPI Number | 1912001470
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Entity Type | Individual
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Provider Name | SAMUEL A. S. GORDON M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 8177 GLADES ROAD, BAY 25
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City | BOCA RATON
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State | FL
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Zip | 33434
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Country | US
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Telephone | 561-472-9975
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Fax |
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Provider Business Mailing Address
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Address Line | 1095 MILITARY TRAIL, BOX # 7716
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City | JUPITER
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State | FL
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Zip | 33468-7716
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Country | US
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Telephone |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME60525
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License Number State | FL
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