Individual
MR. ALAN J GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1750 E GLENDALE AVE, PHOENIX, AZ 85020-5505
(602) 242-4928
(602) 249-4813
Mailing address
1750 E GLENDALE AVE, PHOENIX, AZ 85020-5505
(602) 242-4928
(602) 249-4813
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
20905
AZ
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
20905
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180021122
RAILROAD MEDICARE
AZ
Enumeration date
08/18/2005
Last updated
04/04/2017
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