Provider Demographics
NPI:1063456663
Name:GORDON, HARRY F (MD)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:F
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2600 WESTHALL LANE
Mailing Address - Street 2:BOX 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-200-2300
Mailing Address - Fax:407-200-1365
Practice Address - Street 1:1601 PARK CENTER DR
Practice Address - Street 2:SUITES 3,4,5
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5700
Practice Address - Country:US
Practice Address - Phone:407-351-3673
Practice Address - Fax:407-226-2898
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME56591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10831AMedicare ID - Type Unspecified
FLE12227Medicare UPIN