Individual
JOSHIAH R. GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1600 N GRAND AVE, SUITE 140, PUEBLO, CO 81003-2700
(719) 564-1542
(719) 566-0916
Mailing address
1600 N GRAND AVE, SUITE 140, PUEBLO, CO 81003-2700
(719) 564-1542
(719) 566-0916
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
49719
CO
207RP1001X
Pulmonary Disease Physician
Primary
49719
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952454290
NPI
CO
05
—
37708830
—
CO
Enumeration date
01/19/2007
Last updated
11/14/2013
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