Gordon, Paul Anthony
Gordon, Paul Anthony is an individual health care provider with primary practice located at 124A Professional Park Dr , Conway SC 29526-9260. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Gordon, Paul Anthony can be contacted via phone (843) 347-9500.Contact Information
Primary practice address
124A Professional Park Dr
Conway SC 29526-9260
Phone: (843) 347-9500
Fax: (843) 347-9595
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 9901642 | North Carolina |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 21465 | South Carolina |
Profile Details
| NPI number | 1215931936 |
|---|---|
| LBN Legal business name | Gordon, Paul Anthony |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 9th, 2005 |
| Last updated | Jan 7th, 2010 - about 14 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 | 1215931936 | NPPES |
| South Carolina | MEDICAID | GP4505 | |
| South Carolina | Other | 1244Q | |
| South Carolina | MEDICAID | 891244Q |
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