Provider Demographics
NPI:1821730425
Name:GORDON, KYLE SEBASTIAN (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:SEBASTIAN
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FLORIDA ATLANTIC UNIVERSITY INTERNAL MEDICINE RESIDENCY
Mailing Address - Street 2:800 MEADOWS ROAD
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486
Mailing Address - Country:US
Mailing Address - Phone:561-955-5365
Mailing Address - Fax:
Practice Address - Street 1:FLORIDA ATLANTIC UNIVERSITY INTERNAL MEDICINE RESIDENCY
Practice Address - Street 2:800 MEADOWS ROAD
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-955-5365
Practice Address - Fax:561-955-3577
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program