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:
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Health care specialties

SpecialtyCodeLicense #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 16 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 1215931936 NPPES
South Carolina MEDICAID GP4505
South Carolina Other 1244Q
South Carolina MEDICAID 891244Q

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