Provider Demographics
NPI:1598755043
Name:GORDON, JAMES D (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 692049
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-2049
Mailing Address - Country:US
Mailing Address - Phone:407-846-7546
Mailing Address - Fax:407-933-1001
Practice Address - Street 1:725 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4591
Practice Address - Country:US
Practice Address - Phone:407-846-7546
Practice Address - Fax:407-933-1001
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME88659207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C25463Medicare UPIN
37895ZMedicare ID - Type Unspecified