Gordon, Mark R.
Gordon, Mark R. is an individual health care provider with primary practice located at 620 10Th Street N. , St Petersburg FL 33705-1407. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Gordon, Mark R. can be contacted via phone (727) 824-7146.Contact Information
Primary practice address
620 10Th Street N.
St Petersburg FL 33705-1407
Phone: (727) 824-7146
Fax: (727) 824-7119
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | ME20691 | Florida |
Profile Details
| NPI number | 1275528887 |
|---|---|
| LBN Legal business name | Gordon, Mark R. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 20th, 2005 |
| Last updated | Mar 31st, 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 | 1275528887 | NPPES |
| Florida | MEDICAID | 058923300 |
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