Provider Demographics
NPI:1215038823
Name:KATZ, GORDON J (DO)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:J
Last Name:KATZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E PALMER RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2281
Mailing Address - Country:US
Mailing Address - Phone:937-592-9799
Mailing Address - Fax:937-592-9789
Practice Address - Street 1:1134 N MAIN ST STE 3100
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2379
Practice Address - Country:US
Practice Address - Phone:937-592-9799
Practice Address - Fax:937-592-9789
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4520-K207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH864561OtherMEDICARE
OH0702850Medicaid
OHKA4099403Medicare PIN