Active NPI
Kevin B Gordon, ATC
- Athletic Trainer
- Tampa, FL
National Provider Identifier
1649787367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL2164
- Practice address
- 3618 Madaca LN
Tampa, FL 33618-2057 - Phone
- (813) 978-9700
- NPI assigned
- Jan 3, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL2164 | FL | Primary |
Addresses
Primary practice location
3618 Madaca LN
Tampa, FL 33618-2057
Mailing address
13020 N Telecom Pkwy
Temple Terrace, FL 33637-0925
Phone (813) 978-9700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL2164 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514937600000",
"number": "1649787367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13020 N TELECOM PKWY",
"city": "TEMPLE TERRACE",
"state": "FL",
"postal_code": "336370925",
"telephone_number": "813-978-9700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3618 MADACA LN",
"city": "TAMPA",
"state": "FL",
"postal_code": "336182057",
"telephone_number": "813-978-9700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "KEVIN",
"middle_name": "B",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-01-03",
"last_updated": "2018-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL2164",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.