Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2556 | AL |
Y | 2080P0210X | Pediatric Nephrologist | 2556 | AL |
NPI | 1255838546 |
---|---|
Provider Name | Lindsey Marie Gordon |
First Address | Birmingham, AL 35233-1711 |
Second Address | Birmingham, AL 35233-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2018 |
Last Update Date | 27/08/2021 |