Individual
DR. JONATHAN MARK GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21 SOUTH ST, RIDGEFIELD, CT 06877-4102
(203) 438-6541
Mailing address
21 SOUTH ST, RIDGEFIELD, CT 06877-4102
(203) 438-6541
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
017998
CT
207RP1001X
Pulmonary Disease Physician
017998
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1179985
—
CT
Enumeration date
07/02/2006
Last updated
08/19/2016
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