Individual
SAMUEL ANTONIO GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 1528
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103645
KAISER
—
01
—
247626
MAMSI
—
01
—
512762
NCPPO
—
01
—
5681292
AETNA NON HMO
—
01
—
DC 2528584
AETNA HMO
—
01
—
H360-0004
BS NCA
—
01
—
SMD 3839272
AETNA HMO
—
Enumeration date
08/09/2006
Last updated
12/11/2007
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