Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD 025617L | PA |
NPI | 1063496636 |
---|---|
Provider Name | Arthur Erwin Gordon |
First Address | Phila, PA 19182-0933 |
Second Address | Phila, PA 19115-4634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 18/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0002101 | AETNA HMO (01) | PA |
001688938 | (05) | PA |
0052699000 | INDEPENDENCE BLUE CROSS (01) | PA |
0168893801 | AMERICHOICE (01) | PA |
0168893802 | AMERICHOICE (01) | PA |
1075777 | KMHP (01) | PA |
160058909 | RR MEDICARE (01) | PA |
2Y6155 | HEALTH NET (01) | PA |
30038145 | KMHP (01) | PA |
4556714 | AETNA PPO (01) | PA |
5062 | BRAVO HEALTH (01) | PA |
D68482 | (02) |