Provider Demographics
NPI:1891727970
Name:GORDON, JOHN HAMISH (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HAMISH
Last Name:GORDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3007
Mailing Address - Country:US
Mailing Address - Phone:334-673-3633
Mailing Address - Fax:334-826-2894
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:SUITE 402
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3007
Practice Address - Country:US
Practice Address - Phone:334-673-3633
Practice Address - Fax:334-836-2894
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO 522207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939049Medicaid
AL000032549Medicaid
AL051032549OtherBCBS
AL51015243OtherBCBS
AL000015243Medicare ID - Type Unspecified
AL51015243OtherBCBS
AL009939049Medicaid