Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 19265 | NV |
NPI | 1003266032 |
---|---|
Provider Name | Matthew Gordon |
First Address | Reno, NV 89521-3858 |
Second Address | Reno, NV 89521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2016 |
Last Update Date | 22/11/2019 |