Provider Demographics
NPI:1265584379
Name:GORDON, ROBERT L (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:58 GASPEE POINT DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-4918
Mailing Address - Country:US
Mailing Address - Phone:401-781-1006
Mailing Address - Fax:
Practice Address - Street 1:67 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7274
Practice Address - Country:US
Practice Address - Phone:401-847-4950
Practice Address - Fax:401-847-5767
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37388207P00000X
RIMD04002207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT02644Medicare ID - Type Unspecified