Gordon, Jack William
Gordon, Jack William is an individual health care provider with primary practice located at 320 East Main Street , Crosby MN 56441. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Gordon, Jack William can be contacted via phone (218) 546-7000.Contact Information
Primary practice address
320 East Main Street
Crosby MN 56441
Phone: (218) 546-7000
Fax: (218) 546-4400
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 39563 | Minnesota |
Profile Details
| NPI number | 1578595427 |
|---|---|
| LBN Legal business name | Gordon, Jack William |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 7th, 2006 |
| Last updated | Oct 30th, 2014 - about 11 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578595427 | NPPES |
| Minnesota | MEDICAID | 412444800 |
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