Provider Demographics
NPI:1437585197
Name:CARRUTHERS, GORDON EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:EDWARD
Last Name:CARRUTHERS
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 332
Mailing Address - Street 2:14 APPLEBY DR
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506
Mailing Address - Country:US
Mailing Address - Phone:914-234-7482
Mailing Address - Fax:
Practice Address - Street 1:14 APPLEBY DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506
Practice Address - Country:US
Practice Address - Phone:914-234-7482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084043-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine