Individual
PHILLIP V GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5149 N 9TH AVE, PENSACOLA, FL 32504-8756
(434) 996-4974
Mailing address
20 SEASHORE DR, PENSACOLA BEACH, FL 32561-2427
(434) 996-4974
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101227934
VA
2080N0001X
Neonatal-Perinatal Medicine Physician
115952
FL
2080N0001X
Neonatal-Perinatal Medicine Physician
MD.201795
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006714455
—
VA
05
—
05921278
—
MS
05
—
1036340
—
LA
Enumeration date
11/07/2006
Last updated
09/23/2013
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