Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 0101044678 | VA |
NPI | 1104876853 |
---|---|
Provider Name | Dr. Ian David Gordon |
First Address | Alexandria, VA 22306-3415 |
Second Address | Alexandria, VA 22306-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 28/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E37899 | (02) | VA |