Provider Demographics
NPI:1699053751
Name:NORDINE, GAYLORD CARL (MD)
Entity type:Individual
Prefix:DR
First Name:GAYLORD
Middle Name:CARL
Last Name:NORDINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 65220
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-0220
Mailing Address - Country:US
Mailing Address - Phone:515-223-5511
Mailing Address - Fax:515-225-6258
Practice Address - Street 1:1701 22ND ST
Practice Address - Street 2:# 207
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1443
Practice Address - Country:US
Practice Address - Phone:515-223-5511
Practice Address - Fax:515-225-6258
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA204892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry