Gordon, Bruce Roderick

Gordon, Bruce Roderick is an individual health care provider with primary practice located at 65 Cedar St , Hyannis MA 02601-3009. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Otolaryngic Allergy. Allopathic & Osteopathic Physicians / Otolaryngology is his primary health care specialty. Gordon, Bruce Roderick can be contacted via phone (508) 790-0611.

Contact Information

Primary practice address
65 Cedar St Hyannis MA 02601-3009
Phone: (508) 790-0611
Fax: (508) 790-0589
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 47040 Massachusetts
Allopathic & Osteopathic Physicians / Otolaryngic Allergy 207YX0602X 47040 Massachusetts

Profile Details

NPI number 1467446542
LBN Legal business name Gordon, Bruce Roderick
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 6th, 2005
Last updated Dec 9th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467446542 NPPES
Massachusetts MEDICAID 0142514

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