Gordon, John Edward

Gordon, John Edward is an sole proprietor health care provider with primary practice located at 1200 W. Ironwood Suite # 306, Coeur D' Alene ID 83814. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Gordon, John Edward can be contacted via phone (208) 651-1335.

Contact Information

Primary practice address
1200 W. Ironwood Suite # 306 Coeur D' Alene ID 83814
Fax: (208) 765-0779
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X M-6213 Idaho
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X M-6213 Idaho
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X IDAHOM-6213 Idaho

Profile Details

NPI number 1093868051
LBN Legal business name Gordon, John Edward
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 20th, 2007
Last updated Sep 30th, 2009 - about 15 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 1093868051 NPPES
Idaho MEDICAID 001185400

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