Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 35-05-6322-G | OH |
NPI | 1184688145 |
---|---|
Provider Name | Douglas A. Gordon |
First Address | Cincinnati, OH 45271-0001 |
Second Address | Dayton, OH 45459-3475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 16/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0725933 | (05) | OH |
A17191 | (02) | OH |
P00356846 | RAILROAD MEDICARE (01) | OH |