Provider Demographics
NPI:1194798223
Name:MIDDLETON, GORDON KENNEDY JR (MD)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:KENNEDY
Last Name:MIDDLETON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1321 OBERLIN RD
Mailing Address - Street 2:A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2052
Mailing Address - Country:US
Mailing Address - Phone:919-828-4747
Mailing Address - Fax:919-828-6765
Practice Address - Street 1:1321 OBERLIN RD
Practice Address - Street 2:A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2052
Practice Address - Country:US
Practice Address - Phone:919-828-4747
Practice Address - Fax:919-828-6765
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC10174208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958793Medicaid
NC8958793Medicaid