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Kellroy Gordon
NPI 1184180093 · on the registry since 2019 · sole proprietor
Practice
- Address
- 530 Malabar Rd Sw Apt 202
Palm Bay, FL 32907 - Phone
- (321) 614-5082
Registry record
- Primary taxonomy
- 372600000X
372600000X
- Also registered as
- 372500000X
374700000X
3747P1801X
376J00000X
376K00000X - Licence states on file
- FL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-02-15
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Florida