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Individual
MR. JOHN DAVID GORDON
Active
Individual
MR. JOHN DAVID GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004758
NY
363A00000X
Physician Assistant
MA051642
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU040061
MEDICARE GROUP
PA
01
—
J400278137
MEDICARE PTAN
NY
01
—
P00177089
RR MEDICARE PIN
PA
Enumeration date
03/22/2006
Last updated
03/16/2016
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