MEDICARE: DR. GEOFFREY GORDON M.D.

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
1	207VM0101X	Maternal & Fetal Medicine Physician	63635	WI
2	207VM0101X	Maternal & Fetal Medicine Physician	01079690A	IN
3	207V00000X	Obstetrics & Gynecology Physician	01079690A	IN

General Provider Information

NPI Number	:	1336431139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY GORDON M.D.

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11123 PARKVIEW PLAZA DR STE 204
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1707
Country	:	US
Telephone Number	:	260-266-8380
Fax Number	:	260-266-8385

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2011
Last Update Date	:	03/25/2026

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Directions to “ DR. GEOFFREY GORDON M.D.” Practice Location

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