Provider Demographics
NPI:1316267339
Name:GORDON, DWAYNE KIRK (MD)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:KIRK
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-303-7270
Mailing Address - Fax:407-303-7285
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-303-7270
Practice Address - Fax:407-303-7285
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME116883207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine