Provider Demographics
NPI:1942563267
Name:GORDON, ANN E (AP, DIPLO, OM)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:E
Last Name:GORDON
Suffix:
Gender:F
Credentials:AP, DIPLO, OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W CAMINO REAL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:954-461-9669
Mailing Address - Fax:561-952-6922
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 302
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:954-461-9669
Practice Address - Fax:561-952-6922
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL3132171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist