Provider Demographics
NPI:1528120409
Name:GORDON W AFFLECK MD PC
Entity type:Organization
Organization Name:GORDON W AFFLECK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT GORDON W AFFLECK MD PC
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:W
Authorized Official - Last Name:AFFLECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-292-6356
Mailing Address - Street 1:1517 S 1500 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010
Mailing Address - Country:US
Mailing Address - Phone:801-292-6356
Mailing Address - Fax:801-292-6356
Practice Address - Street 1:1517 S 1500 E
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:801-292-6356
Practice Address - Fax:801-292-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA8675665OtherDEA