Individual
GARY M GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2285 CROSS RD, GLENSIDE, PA 19038-5023
(215) 887-5910
(215) 887-0387
Mailing address
2285 CROSS RD, GLENSIDE, PA 19038-5023
(215) 887-5910
(215) 887-0387
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC001507L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015356250001
—
PA
01
—
0060610000
KEYSTONE/AMERIHEALTH
PA
01
—
30002264
KEYSTONE MERCY
PA
01
—
7305038
AETNA
PA
Enumeration date
08/02/2005
Last updated
03/18/2008
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