Provider Demographics
NPI:1407949332
Name:GORDON, DAVID LEE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:GORDON
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 1:4530 SOUTHLAKE PKWY # A
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3237
Mailing Address - Country:US
Mailing Address - Phone:205-987-2845
Mailing Address - Fax:205-987-9407
Practice Address - Street 1:4530 SOUTHLAKE PKWY # A
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3237
Practice Address - Country:US
Practice Address - Phone:205-987-2845
Practice Address - Fax:205-987-9407
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9865174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC73398Medicare UPIN