Gordon, Charles S

Gordon, Charles S is an individual health care provider with primary practice located at 512 Nokomis Ave S , Venice FL 34285-2817. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Gordon, Charles S can be contacted via phone (941) 488-7781.

Contact Information

Primary practice address
512 Nokomis Ave S Venice FL 34285-2817
Phone: (941) 488-7781
Fax: (941) 484-9235
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X ME0068812 Florida
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X ME0068812 Florida

Profile Details

NPI number 1679516124
LBN Legal business name Gordon, Charles S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Jun 29th, 2020 - about 5 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 1679516124 NPPES
Florida MEDICAID 265320600

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