Individual
DOUGLAS A. GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7677 YANKEE ST, SUITE 110, DAYTON, OH 45459-3475
(937) 415-9100
(937) 415-9191
Mailing address
PO BOX 713130, CINCINNATI, OH 45271-0001
(937) 415-9100
(937) 415-9191
Taxonomy
Speciality
Code
Description
License number
State
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
35-05-6322-G
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0725933
—
OH
01
—
P00356846
RAILROAD MEDICARE
OH
Enumeration date
04/14/2006
Last updated
03/16/2012
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