Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 34-001806 | OH |
NPI | 1821016122 |
---|---|
Provider Name | Donald J. Gordon |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 16/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000221070 | UNISON (01) | OH |
000000503587 | ANTHEM (01) | OH |
0304914 | BCMH (01) | OH |
0356145 | (05) | OH |
1025735250001 | (05) | PA |
363572 | WELLCARE (01) | OH |
4092556 | AETNA (01) | OH |
746265 | BUCKEYE (01) | OH |
A77428 | (02) | |
P00364283 | RAILROAD MEDICARE (01) | OH |