Provider Demographics
NPI:1982982351
Name:MARSDEN, GORDON ROY (PA-C)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:ROY
Last Name:MARSDEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 BLUEBIRD PASS
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523-9293
Mailing Address - Country:US
Mailing Address - Phone:608-695-6872
Mailing Address - Fax:
Practice Address - Street 1:813 BLUEBIRD PASS
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53523-9293
Practice Address - Country:US
Practice Address - Phone:608-695-6872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2803-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1982982351Medicaid
WI1982982351Medicaid