Provider Demographics
NPI:1851482186
Name:GORDON, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3106 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5406
Mailing Address - Country:US
Mailing Address - Phone:504-885-8318
Mailing Address - Fax:504-455-4104
Practice Address - Street 1:3106 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5406
Practice Address - Country:US
Practice Address - Phone:504-885-8318
Practice Address - Fax:504-455-4104
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.023665208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA720914303OtherTAX ID NUMBER