Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | VG004757 | MI |
NPI | 1053319079 |
---|---|
Provider Name | Dr. Victor Gordon |
First Address | Farmington Hills, MI 48336-5967 |
Second Address | Farmington Hills, MI 48336-5967 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 08/07/2007 |