Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 217197 | MA |
Y | 111NI0900X | Internist | 217197 | MA |
N | 207RC0200X | Critical Care Medicine | 217197 | MA |
N | 207RP1001X | Pulmonary Disease | 217197 | MA |
NPI | 1043297070 |
---|---|
Provider Name | Dr. Patrick Livius Gordan |
First Address | Salem, MA 01970-2768 |
Second Address | Salem, MA 01970-2714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 13/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2016761 | (05) | MA |
H91423 | (02) |