Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | ME0047490 | FL |
N | 207R00000X | Internist | 0047490 | FL |
N | 111NI0900X | Internist | 0047490 | FL |
NPI | 1013905629 |
---|---|
Provider Name | Michael D. Gordon |
First Address | Apopka, FL 32703-5943 |
Second Address | Apopka, FL 32703-5943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D50348 | (02) |