Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101256842 | VA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | D0078288 | MD |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD042668 | DC |
N | 2081S0010X | Sports Medicine | 0101256842 | VA |
N | 213ES0000X | Sports Medicine | 0101256842 | VA |
N | 2081S0010X | Sports Medicine | D0078288 | MD |
N | 213ES0000X | Sports Medicine | D0078288 | MD |
N | 2081S0010X | Sports Medicine | MD042668 | DC |
N | 213ES0000X | Sports Medicine | MD042668 | DC |
NPI | 1013232628 |
---|---|
Provider Name | Dr. Andrew Harris Gordon |
First Address | The Woodlands, TX 77380-0995 |
Second Address | Reston, VA 20190-3298 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2010 |
Last Update Date | 29/05/2021 |