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NPI Code Detail

MEDICARE: DR. GORDON ALAN BEARDWOOD MD

MEDICARE: DR. GORDON ALAN BEARDWOOD 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
1207L00000XAnesthesiology Physician60395MN
2207LP2900XPain Medicine (Anesthesiology) Physician60395MN

General Provider Information

NPI Number : 1316938038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GORDON ALAN BEARDWOOD MD
Provider Business Mailing Address
First Line : 701 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55415-1623
Country : US
Telephone Number : 612-873-3000
Fax Number :
Provider Business Practice Location Address
First Line : 715 S 8TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-7530
Country : US
Telephone Number : 612-873-6963
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 03/24/2025

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