Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 035181 | CT |
NPI | 1780734608 |
---|---|
Provider Name | Dr. Neil Alan Gordon |
First Address | Wilton, CT 06897-2216 |
Second Address | Wilton, CT 06897-2216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G28230 | (02) | CT |