| David P. Gordon, Ltd. | |
|
1516 W Lake St Ste 304 Minneapolis MN 55408-6601 | |
| (612) 281-7773 | |
| Not Available |
| Full Name | David P. Gordon, Ltd. |
|---|---|
| Speciality | Psychoanalyst |
| Location | 1516 W Lake St Ste 304, Minneapolis, Minnesota |
| Authorized Official Name and Position | David P. Gordon (CEO) |
| Authorized Official Contact | 6122817773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David P. Gordon, Ltd. 1516 W Lake St Ste 304 Minneapolis MN 55408-6601 Ph: (612) 281-7773 | David P. Gordon, Ltd. 1516 W Lake St Ste 304 Minneapolis MN 55408-6601 Ph: (612) 281-7773 |
| NPI Number | 1023273349 |
|---|---|
| Provider Enumeration Date | 07/25/2008 |
| Last Update Date | 07/25/2008 |
| Medicare PECOS PAC ID | 2860553575 |
|---|---|
| Medicare Enrollment ID | O20081212000195 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023273349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 102L00000X | Psychoanalyst | 01545 (Minnesota) | Primary |
| Provider Name | David P Gordon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619197993 PECOS PAC ID: 9537106562 Enrollment ID: I20050412000558 |
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