Basic Information
| Provider Information | |||||||||
| NPI: | 1063456663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | HARRY | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 WESTHALL LANE | ||||||||
| Address2: | BOX 300 | ||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072002300 | ||||||||
| FaxNumber: | 4072001365 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 PARK CENTER DR | ||||||||
| Address2: | SUITES 3,4,5 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328355700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073513673 | ||||||||
| FaxNumber: | 4072262898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME56591 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.