Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 26409 | CA |
NPI | 1083795462 |
---|---|
Provider Name | Dr. Newton Charles Gordon |
First Address | San Francisco, CA 94110-3518 |
Second Address | San Francisco, CA 94110-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T08749 | (02) |