Individual
PETER T GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
259 MAIN ST, YARMOUTH, ME 04096-6723
(207) 846-9013
(207) 523-8586
Mailing address
100 GANNETT DR, SUITE C, SOUTH PORTLAND, ME 04106-5900
(207) 828-0361
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
012591
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010557
ANTHEM
—
01
—
1040906
AETNA
—
05
—
311660099
—
ME
Enumeration date
03/18/2006
Last updated
07/28/2016
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