Provider Demographics
NPI:1740228071
Name:GORDON, MARGERY ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARGERY
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3702 NEW VISION DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:885 W CONNEXION WAY STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725
Practice Address - Country:US
Practice Address - Phone:260-248-9260
Practice Address - Fax:260-248-9279
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009791L207Q00000X
IN02005540A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002922FSCMedicare PIN