Individual
DOUGLAS M GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 W COCOA BEACH CSWY, COCOA BEACH, FL 32931-3585
(321) 799-7111
(770) 621-3181
Mailing address
PO BOX 2400, MELBOURNE, FL 32902-2400
(866) 744-1461
(770) 621-3181
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
ME64194
FL
2085N0904X
Nuclear Radiology Physician
ME64194
FL
2085P0229X
Pediatric Radiology Physician
ME64194
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME64194
FL
2085R0204X
Vascular & Interventional Radiology Physician
ME64194
FL
2085U0001X
Diagnostic Ultrasound Physician
ME64194
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23388
BCBS
FL
01
—
23388Z
MEDICARE PTAN
FL
01
—
300048844
MEDICARE RR
—
05
—
377261600
—
FL
Enumeration date
11/30/2006
Last updated
08/05/2013
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