Individual
JACOB GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34 HAVERHILL ST, LAWRENCE, MA 01841-2884
(978) 688-1567
Mailing address
34 HAVERHILL ST, LAWRENCE, MA 01841-2884
(978) 688-1567
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ETLL-1093
MA
Other
Enumeration date
04/19/2020
Last updated
06/18/2020
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