Provider Demographics
NPI:1083809214
Name:ANTHONY S GORDON, MDPC
Entity Type:Organization
Organization Name:ANTHONY S GORDON, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-571-9433
Mailing Address - Street 1:9844 S 1300 E
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4673
Mailing Address - Country:US
Mailing Address - Phone:801-571-9433
Mailing Address - Fax:801-572-5607
Practice Address - Street 1:9844 S 1300 E
Practice Address - Street 2:SUITE #100
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4673
Practice Address - Country:US
Practice Address - Phone:801-571-9433
Practice Address - Fax:801-572-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT263767-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE93611Medicare UPIN
UT000058065Medicare PIN