Individual
ANTHONY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1907 W SYCAMORE ST, KOKOMO, IN 46901-5148
(765) 456-5433
Mailing address
1907 W SYCAMORE ST, KOKOMO, IN 46901-5148
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01074452A
IN
207Q00000X
Family Medicine Physician
Primary
01074452A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201185010
—
IN
Enumeration date
04/04/2013
Last updated
01/24/2023
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