Active NPI
George Gordon
- Prevention Professional
- Boynton Beach, FL
National Provider Identifier
1942858329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 00000
- Practice address
- 4895 Windward Passage Dr Ste 6
Boynton Beach, FL 33436-7741 - Phone
- (561) 877-8753
- NPI assigned
- Aug 29, 2019
- Last updated
- Aug 29, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 00000 | FL | Primary |
Addresses
Primary practice location
4895 Windward Passage Dr Ste 6
Boynton Beach, FL 33436-7741
Mailing address
4895 Windward Passage Dr Ste 6
Boynton Beach, FL 33436-7741
Phone (561) 877-8753
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 |
|---|---|---|---|
| 00000 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567036800000",
"number": "1942858329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4895 WINDWARD PASSAGE DR STE 6",
"city": "BOYNTON BEACH",
"state": "FL",
"postal_code": "334367741",
"telephone_number": "561-877-8753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4895 WINDWARD PASSAGE DR STE 6",
"city": "BOYNTON BEACH",
"state": "FL",
"postal_code": "334367741",
"telephone_number": "561-877-8753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "GEORGE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-08-29",
"last_updated": "2019-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "FL",
"license": "00000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boynton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.