1184944357 NPI number — MRS. NIHJA OLIVER GORDON MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184944357 NPI number — MRS. NIHJA OLIVER GORDON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORDON
Provider First Name:
NIHJA
Provider Middle Name:
OLIVER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLIVER
Provider Other First Name:
NIHJA
Provider Other Middle Name:
BRYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184944357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6200 SW 73RD STREET
Provider Second Line Business Mailing Address:
SOUTH MIAMI CRITICARE, INC.
Provider Business Mailing Address City Name:
SOUTH MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-662-0455
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6200 SW 73RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33143-4679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-662-0455
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  ME123003 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 01073539A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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