Individual
BRUCE RODERICK GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
65 CEDAR ST, HYANNIS, MA 02601-3009
(508) 790-0611
(508) 790-0589
Mailing address
65 CEDAR ST, HYANNIS, MA 02601-3009
(508) 790-0611
(508) 790-0589
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
47040
MA
207YX0602X
Otolaryngic Allergy Physician
47040
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0142514
—
MA
Enumeration date
09/06/2005
Last updated
12/09/2011
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