Organization
JEREMY M GORDON DC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY M GORDON DC (PRESIDENT)
(386) 734-9995
Entity
Organization
Contact information
Practice address
905 N STONE ST, DELAND, FL 32720-2521
(386) 734-9995
(386) 734-9949
Mailing address
905 N STONE ST, DELAND, FL 32720-2521
(386) 734-9995
(386) 734-9949
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
CH7770
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55875
BLUE CROSS BLUE SHIELD
FL
Enumeration date
10/13/2006
Last updated
10/29/2010
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