Federico Gordon Jr., MBA, MLS(ASCP)

Primary specialty

Pathology Specialist/TechnologistTaxonomy code 246Q00000X

License

SU37305 Issued in FL

Practice address

601 S Harbour Island Blvd Ste 109
Tampa, FL 33602-5927

Phone

(813) 419-2934

NPI assigned

May 21, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590364800000",
    "number": "1174146302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S HARBOUR ISLAND BLVD STE 109",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336025927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S HARBOUR ISLAND BLVD STE 109",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336025927",
            "telephone_number": "813-419-2934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "FEDERICO",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MBA, MLS(ASCP)",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-21",
        "last_updated": "2020-05-25",
        "certification_date": "2020-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Q00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Pathology",
            "state": "FL",
            "license": "SU37305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.humblefax.com",
            "affiliation": "N",
            "address_1": "601 S Harbour Island Blvd Ste 109",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336025927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ruth Gordon-Martin
• Athena Boolukos Gordon, EDM, PSYD
• Carla Gordon
• Charity J Gordon, APRN
• Cherie Gordon, ARNP
• Jessica Marie Gordon, ARNP
• Joellen Gordon, PHYSICIAN ASSISTANT
• Kevin B Gordon, ATC
• Kourtney Gordon, MS,RD/LD,CEDRD
• Madelynn Gordon

• Pathology Specialist/Technologist in Tampa, FL
• Providers in Tampa, FL by specialty
• Pathology Specialist/Technologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.