Individual
MR. JOHN EDWARD GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 W. IRONWOOD, SUITE # 306, COEUR D' ALENE, ID 83814
(208) 651-1335
(208) 765-0779
Mailing address
1200 W. IRONWOOD, SUITE # 306, COEUR D' ALENE, ID 83814
(208) 651-1335
(208) 765-0779
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
IDAHOM-6213
ID
2084P0800X
Psychiatry Physician
M-6213
ID
2084P0804X
Child & Adolescent Psychiatry Physician
M-6213
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001185400
—
ID
Enumeration date
01/20/2007
Last updated
09/30/2009
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