Provider Demographics
NPI:1528279809
Name:GORDON, BRIAN STEWART (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:STEWART
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:38 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2220
Mailing Address - Country:US
Mailing Address - Phone:330-759-1182
Mailing Address - Fax:330-824-6403
Practice Address - Street 1:2310 HALLOCK-YOUNG RD.
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44482
Practice Address - Country:US
Practice Address - Phone:330-824-6016
Practice Address - Fax:330-824-6403
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042363207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine