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
Phone: (208) 651-1335
Fax: (208) 765-0779
Website:
Health care specialties
Specialty | Code | License # | 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1093868051 | NPPES |
Idaho | MEDICAID | 001185400 |
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