Individual
MR. MARTIN A GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
37390 N BRADUM RD, BAYFIELD, WI 54814-4832
(715) 779-3741
(715) 779-3765
Mailing address
PO BOX 529, BAYFIELD, WI 54814-0529
(715) 779-3707
(715) 779-3711
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11815
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39372600
—
WI
Enumeration date
10/04/2006
Last updated
07/08/2007
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