Provider Demographics
NPI:1710320163
Name:GORDON, DANA PAIGE (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:PAIGE
Last Name:GORDON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2404
Mailing Address - Country:US
Mailing Address - Phone:305-335-1181
Mailing Address - Fax:
Practice Address - Street 1:500 S SHORE DR
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-2404
Practice Address - Country:US
Practice Address - Phone:305-335-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW215176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife