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NPI Code Detail

MEDICARE: MEREDITH LEIGH FISHBANE GORDON M.D.

MEDICARE: MEREDITH LEIGH FISHBANE 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
1208000000XPediatrics Physician231765MA
2208000000XPediatrics PhysicianMD429411PA
3208000000XPediatrics PhysicianMD-41814IA

General Provider Information

NPI Number : 1417165614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEREDITH LEIGH FISHBANE GORDON M.D.
Provider Business Mailing Address
First Line : 1130 S SCOTT BLVD
Second Line : UICMS SOUTHEAST CLINIC - GENERAL PEDIATRICS
City : IOWA CITY
State : IA
Zip : 52240-2907
Country : US
Telephone Number : 319-467-6789
Fax Number :
Provider Business Practice Location Address
First Line : 1130 S SCOTT BLVD
Second Line : UICMS SOUTHEAST CLINIC - GENERAL PEDIATRICS
City : IOWA CITY
State : IA
Zip : 52240-2907
Country : US
Telephone Number : 319-467-6789
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2007
Last Update Date : 04/08/2015

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