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NPI Code Detail

MEDICARE: DONAL KEVIN GORDON MD

MEDICARE: DONAL KEVIN GORDON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician36376IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00731432OTHERRR MEDICARE MEMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013971092
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONAL KEVIN GORDON MD
Provider Business Mailing Address
First Line : PO BOX 2205
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52406-2205
Country : US
Telephone Number : 319-730-7300
Fax Number :
Provider Business Practice Location Address
First Line : 1201 3RD AVE SE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52403-4009
Country : US
Telephone Number : 319-730-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 12/12/2011

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