Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 8424 | MA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 246483 | MA |
NPI | 1164448171 |
---|---|
Provider Name | Dr. Paul E Gordon |
First Address | Burlington, MA 01803-5154 |
Second Address | Burlington, MA 01803-5154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 09/05/2019 |