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NPI Code Detail

MEDICARE: GORDON ABERNATHIE D.O.

MEDICARE: GORDON ABERNATHIE D.O.
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 Physician2799SD

General Provider Information

NPI Number : 1053316174
Entity Type Code : Individual
Provider Name (Legal Business Name) : GORDON ABERNATHIE D.O.
Provider Business Mailing Address
First Line : 5410 SHERIDAN LAKE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-9208
Country : US
Telephone Number : 605-348-4141
Fax Number : 605-342-7880
Provider Business Practice Location Address
First Line : 5410 SHERIDAN LAKE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-9208
Country : US
Telephone Number : 605-348-4141
Fax Number : 605-342-7880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 09/02/2010

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Directions to “ GORDON ABERNATHIE D.O.” Practice Location

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