Individual
GORDON F MCMICHAEL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HM1, USN
Contact information
Practice address
75 OSPREY DR, GROTON, CT 06340-3150
(814) 923-7721
Mailing address
75 OSPREY DR, GROTON, CT 06340-3150
(814) 923-7721
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/03/2024
Last updated
01/03/2024
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