Active NPI
Brian Phillip Glen Gordon Sr.
- Driver
- Buffalo, NY
National Provider Identifier
1740509165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- 607953011
- Practice address
- 29 Cambridge Ave
29 Cambridge Ave.
Buffalo, NY 14215-4001 - Phone
- (716) 931-9899
- NPI assigned
- May 25, 2010
- 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 |
|---|---|---|---|---|
| Driver | 172A00000X | 607953011 | NY | Primary |
Addresses
Primary practice location
29 Cambridge Ave
29 Cambridge Ave.
Buffalo, NY 14215-4001
Mailing address
29 Cambridge Ave
29 Cambridge Ave.
Buffalo, NY 14215-4001
Phone (716) 931-9899
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 |
|---|---|---|---|
| 607953011 | NY | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274745600000",
"number": "1740509165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 CAMBRIDGE AVE",
"address_2": "29 CAMBRIDGE AVE.",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142154001",
"telephone_number": "716-931-9899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 CAMBRIDGE AVE",
"address_2": "29 CAMBRIDGE AVE.",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142154001",
"telephone_number": "716-931-9899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "BRIAN",
"middle_name": "PHILLIP GLEN",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-05-25",
"last_updated": "2010-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "NY",
"license": "607953011",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.