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NPI Code Detail

MEDICARE: JOSHUA GORDON CAA

MEDICARE: JOSHUA GORDON CAA
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
1367H00000XAnesthesiologist AssistantTX
2367H00000XAnesthesiologist Assistant75000251AIN
3367H00000XAnesthesiologist Assistant62058GA

General Provider Information

NPI Number : 1205322302
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA GORDON CAA
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5165 MCCARTY LN
Second Line :
City : LAFAYETTE
State : IN
Zip : 47905-8764
Country : US
Telephone Number : 765-448-8000
Fax Number : 765-838-4758
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2018
Last Update Date : 04/14/2026

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Directions to “ JOSHUA GORDON CAA” Practice Location

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