Drexel Reed Gordon, D.O. – Family Medicine Physician

Key facts

NPI: 1992891584
Entity type: Individual (NPI type 1)
Primary specialty: Family Medicine Physician 207Q00000X
License: 1454 (ME)
Practice address: 8 Depot St
Ste 2
Bridgton, ME 04009-1368
Phone: (207) 647-5499
Fax: (207) 647-5931
NPI assigned: Oct 4, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Central Maine Conditioning Clinic, Inc Specialist · Auburn, ME · NPI 1396971511

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Osteopathy

State licenses

License	State	Type	Specialty
1454	ME	MD	Family Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
Central Maine Conditioning Clinic, Inc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Family Medicine Physician	207Q00000X	1454	ME	Yes

Addresses

Primary practice location

8 Depot St
Ste 2
Bridgton, ME 04009-1368

Mailing address

8 Depot St
Ste 2
Bridgton, ME 04009-1368
Phone (207) 647-5499

Other identifiers

Identifier	Type	State	Issuer
234110099	Medicaid	ME

Other providers in Bridgton, ME

All providers in Bridgton, ME · Family Medicine Physician in Maine

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2017. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.