Provider Demographics
NPI:1811222045
Name:GORDON, ALICE H (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:H
Last Name:GORDON
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:7351 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-7107
Mailing Address - Country:US
Mailing Address - Phone:954-749-6955
Mailing Address - Fax:954-578-2783
Practice Address - Street 1:260 SW 84TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2715
Practice Address - Country:US
Practice Address - Phone:954-370-8585
Practice Address - Fax:954-370-1585
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2014-07-03
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105207363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical