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Organization
GARY M GORDON DPM PC
Active
Organization
GARY M GORDON DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY M GORDON DPM (PRESIDENT)
(215) 887-5910
Entity
Organization
Contact information
Practice address
2285 CROSS RD, GLENSIDE, PA 19038
(215) 887-5910
(215) 887-0387
Mailing address
2285 CROSS RD, GLENSIDE, PA 19038
(215) 887-5910
(215) 887-0387
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC00L57L
PA
332B00000X
Durable Medical Equipment & Medical Supplies
SC001507L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000118918
PA BLUE SHIELD
—
01
—
0060635000
KEYSTONE
—
01
—
1991
AETNA HMO
—
01
—
7305038
AETNA
—
Enumeration date
10/25/2006
Last updated
03/18/2008
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