Provider Demographics
NPI:1205012614
Name:GORDER, HOWARD ARNOLD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:ARNOLD
Last Name:GORDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEISKA
Mailing Address - State:MN
Mailing Address - Zip Code:55910-9622
Mailing Address - Country:US
Mailing Address - Phone:507-206-9867
Mailing Address - Fax:
Practice Address - Street 1:210 9TH ST SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6756
Practice Address - Country:US
Practice Address - Phone:507-206-9867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10389363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10389OtherSTATE LICENSE #
1074984OtherPANCE / NCCPA ID