Individual
ELLEN E I GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-4821
(319) 356-4552
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-4821
(319) 356-4552
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
24875
IA
207RC0000X
Cardiovascular Disease Physician
Primary
24875
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0228809
—
IA
01
—
22880
WELLMARK BCBS
IA
Enumeration date
10/13/2005
Last updated
12/04/2007
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