Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD36872 | AL |
NPI | 1275825135 |
---|---|
Provider Name | Dr. Charles Marvin Gordon JR. |
First Address | Daphne, AL 36526-4298 |
Second Address | Daphne, AL 36526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2011 |
Last Update Date | 01/08/2018 |