Individual
D GORDON ALLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 S KOKE MILL RD, SPRINGFIELD, IL 62711-9252
(217) 547-9100
(217) 547-9247
Mailing address
PO BOX 9469, SPRINGFIELD, IL 62791-9469
(217) 547-9100
(217) 547-9247
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036079986
IL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
036079986
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036079986
—
IL
01
—
P00692114
RAILROAD MEDICARE
IL
Enumeration date
09/27/2005
Last updated
03/13/2023
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