Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 11619971-1205 | UT |
NPI | 1346629110 |
---|---|
Provider Name | Dr. Steven A. Gordon |
First Address | Salt Lake City, UT 84132-0001 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 02/11/2021 |