Active NPI
Mickey E. Gordon, DPM
- Podiatrist
- Naples, FL
National Provider Identifier
1689644882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- PO2638
- Practice address
- 9955 Tamiami TRL N
Suite 1
Naples, FL 34108-1914 - Phone
- (239) 566-8800
- Fax
- (239) 566-8778
- NPI assigned
- Jan 23, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | PO2638 | FL | Primary |
| Podiatrist | 213E00000X | 0936 | MI | |
| Podiatrist | 213E00000X | 187 | NM |
Addresses
Primary practice location
9955 Tamiami TRL N
Suite 1
Naples, FL 34108-1914
Mailing address
9955 Tamiami TRL N
Suite 1
Naples, FL 34108-1914
Phone (239) 566-8800
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5782609 | Other | FL | AETNA PROVIDER # |
| 65543 | Other | FL | BC/BS PROVIDER # |
| K6801 | Other | FL | MEDICARE ID |
| 0936 | Other | MI | PODIATRIC MEDICAL LICENSE |
| 187 | Other | NM | PODIATRIC MEDICAL LICENSE |
| PO2638 | Other | FL | PODIATRIC MEDICAL LICENSE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PO2638 | FL | MD | Podiatrist |
| 0936 | MI | MD | Podiatrist |
| 187 | NM | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206921600000",
"number": "1689644882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9955 TAMIAMI TRL N",
"address_2": "SUITE 1",
"city": "NAPLES",
"state": "FL",
"postal_code": "341081914",
"telephone_number": "239-566-8800",
"fax_number": "239-566-8778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9955 TAMIAMI TRL N",
"address_2": "SUITE 1",
"city": "NAPLES",
"state": "FL",
"postal_code": "341081914",
"telephone_number": "239-566-8800",
"fax_number": "239-566-8778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "MICKEY",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-23",
"last_updated": "2008-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "FL",
"license": "PO2638",
"primary": true
},
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "MI",
"license": "0936",
"primary": false
},
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NM",
"license": "187",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER #",
"identifier": "5782609",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS PROVIDER #",
"identifier": "65543",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID",
"identifier": "K6801",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PODIATRIC MEDICAL LICENSE",
"identifier": "0936",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PODIATRIC MEDICAL LICENSE",
"identifier": "187",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PODIATRIC MEDICAL LICENSE",
"identifier": "PO2638",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Naples, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.