Provider Demographics
NPI:1396745782
Name:GORDON, ANTONIO MARIA JR (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:MARIA
Last Name:GORDON
Suffix:JR
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 1:8210 NW 27TH ST
Mailing Address - Street 2:STE 205
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1900
Mailing Address - Country:US
Mailing Address - Phone:305-556-6459
Mailing Address - Fax:
Practice Address - Street 1:5351 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2269
Practice Address - Country:US
Practice Address - Phone:305-901-1191
Practice Address - Fax:786-615-5635
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2025-04-25
Deactivation Date:2005-09-01
Deactivation Code:
Reactivation Date:2007-12-27
Provider Licenses
StateLicense IDTaxonomies
FL0028982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036786900Medicaid
FL036786900Medicaid
79262Medicare ID - Type Unspecified