Provider Demographics
NPI:1700866118
Name:GORDON, ELISE TREFF (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:TREFF
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELISE
Other - Middle Name:SUZANNE
Other - Last Name:TREFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:760 EAST AVE BLDG 3911
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-5136
Mailing Address - Country:US
Mailing Address - Phone:850-452-8970
Mailing Address - Fax:850-452-8979
Practice Address - Street 1:760 EAST AVE BLDG 3911
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-5136
Practice Address - Country:US
Practice Address - Phone:850-452-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109095207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003558200Medicaid
FL14E5ROtherBLUE CROSS BLUE SHIELD
AL592-15141OtherBLUE CROSS BLUE SHIELD
AL128079Medicaid
AL592-15140OtherBLUE CROSS BLUE SHIELD
AL128081Medicaid
FLEM972ZMedicare PIN