Gordon, Derek Michael

Gordon, Derek Michael is an individual health care provider with primary practice located at 2809 Denny Ave , Pascagoula MS 39581-5301. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Gordon, Derek Michael can be contacted via phone (228) 809-5000.

Contact Information

Primary practice address
2809 Denny Ave Pascagoula MS 39581-5301
Phone: (228) 809-5000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 25109 Louisiana
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 19264 Mississippi

Profile Details

NPI number 1265400485
LBN Legal business name Gordon, Derek Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated Dec 2nd, 2013 - about 12 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 1265400485 NPPES
Louisiana MEDICAID 1U20883

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