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NPI Code Detail

MEDICARE: GORDON NEAL WILLIFORD PA-C

MEDICARE: GORDON NEAL WILLIFORD PA-C
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
1363AM0700XMedical Physician AssistantPA9101137FL

General Provider Information

NPI Number : 1235128380
Entity Type Code : Individual
Provider Name (Legal Business Name) : GORDON NEAL WILLIFORD PA-C
Provider Business Mailing Address
First Line : PO BOX 8060
Second Line :
City : SEBRING
State : FL
Zip : 33872-0118
Country : US
Telephone Number : 863-402-3119
Fax Number :
Provider Business Practice Location Address
First Line : 4200 SUN N LAKE BLVD
Second Line : EMERGENCY DEPARTMENT
City : SEBRING
State : FL
Zip : 33872-1986
Country : US
Telephone Number : 863-402-3119
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 07/08/2007

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Directions to “ GORDON NEAL WILLIFORD PA-C” Practice Location

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