Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | C1-0013322 | DE |
N | 208000000X | Pediatrician | ME135539 | FL |
Y | 2080A0000X | Adolescent Medicine | ME135539 | FL |
NPI | 1235368945 |
---|---|
Provider Name | Dr. Lonna Gordon |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Orlando, FL 32827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2009 |
Last Update Date | 31/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
024920900 | (05) | FL |