Individual
DR. THEODORE G GOURDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1962 CHARLIE HALL BLVD, CHARLESTON, SC 29414-5837
(843) 722-8000
(843) 647-6066
Mailing address
2001 2ND AVE STE 101, SUMMERVILLE, SC 29486-7887
(843) 793-5182
(843) 266-5125
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
13033
SC
207RG0100X
Gastroenterology Physician
Primary
13033
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130334
—
SC
Enumeration date
06/21/2005
Last updated
05/07/2020
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