Individual
LEONARD B GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC/SMDR
Contact information
Practice address
COMNAVSURFLANT N02M, 1430 MITSCHER AVE, NORFOLK, VA 23551-2494
(904) 718-0427
Mailing address
COMNAVSURFLANT N02M, 1430 MITSCHER AVE, NORFOLK, VA 23551-2494
(904) 316-6737
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/01/2011
Last updated
05/04/2011
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