Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | DS040604 | PA |
NPI | 1548637192 |
---|---|
Provider Name | Taylor R. Gordon |
First Address | Pittsburgh, PA 15213-2523 |
Second Address | Pittsburgh, PA 15213-2523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2015 |
Last Update Date | 08/05/2017 |