MEDICARE: KAITLYN GORDON 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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1336726298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN GORDON MD

Provider Business Mailing Address
First Line	:	1105 11TH LN
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3556
Country	:	US
Telephone Number	:	561-602-9766
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-3182
Fax Number	:	336-716-5168

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

Provider Enumeration Date	:	03/26/2021
Last Update Date	:	02/03/2026

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