Provider Demographics
NPI:1346208915
Name:GIEG, GORDON G (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:G
Last Name:GIEG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-0850
Mailing Address - Country:US
Mailing Address - Phone:802-985-2585
Mailing Address - Fax:802-985-5092
Practice Address - Street 1:5138 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6698
Practice Address - Country:US
Practice Address - Phone:802-985-2585
Practice Address - Fax:802-985-5092
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0011613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine