Individual
MR. BRIAN PHILLIP GLEN GORDON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
29 CAMBRIDGE AVE, 29 CAMBRIDGE AVE., BUFFALO, NY 14215-4001
(716) 931-9899
Mailing address
29 CAMBRIDGE AVE, 29 CAMBRIDGE AVE., BUFFALO, NY 14215-4001
(716) 931-9899
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
607953011
NY
Other
Enumeration date
05/25/2010
Last updated
05/25/2010
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