Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 036163 | GA |
NPI | 1083939391 |
---|---|
Provider Name | Dr. Robert Dana Gordon |
First Address | Atlanta, GA 30328-6202 |
Second Address | Atlanta, GA 30328-6202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2010 |
Last Update Date | 30/03/2010 |