FREDERICK WALTER GOURDIN (NPI# 1215902663) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1215902663 |
Entity Type | Individual |
Full Name | FREDERICK WALTER GOURDIN |
Credential | MD |
Practice Address |
78 Long Shoals Rd Arden NC 28704-7782 |
Practice Telephone | 8286840703 |
Practice Fax Number | 8286845344 |
Mailing Telephone | 8286840703 |
Mailing Fax Number | 8286845344 |
Enumeration Date | 2006-02-21 |
Last Update Date | 2007-07-09 |
Gender Code | M |
Is Sole Proprietor | X |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
9800549 | NC | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NC | 8911375 | 05 |
Street Address |
78 LONG SHOALS RD |
City | ARDEN |
State | NC |
Zip Code | 28704-7782 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508183286 | Christopher Ryan Urban | Dermatology | 78 Long Shoals Rd, Arden, NC 28704-7782 | 2010-04-21 |
1982669131 | Carolina Mountain Dermatology, Pa | Dermatology | 78 Long Shoals Rd, Arden, NC 28704-7782 | 2006-04-19 |
1912972811 | Michael David Cogburn | Dermatology | 78 Long Shoals Rd, Arden, NC 28704-7782 | 2006-02-22 |
1275508285 | Jay L Clarke | Physician Assistant | 78 Long Shoals Rd, Arden, NC 28704-7782 | 2006-02-22 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1801410949 | Lindsey Marie Gates | Dentist | 226 New Airport Rd Ste 30, Arden, NC 28704 | 2020-06-04 |
1669025565 | Casey Cho Dds Pllc | Dentist | 150 Airport Rd. Suite 30, Arden, NC 28704 | 2019-07-19 |
1700370913 | Eric Seth Shapiro | Chiropractor | 32 Southwicke Dr, Arden, NC 28704 | 2018-06-20 |
1285180406 | Adam Herbst | Physical Therapy Assistant | 101 Roberts Lake Circle Apt 105, Arden, NC 28704 | 2016-08-28 |
1760820013 | Dove Shoneman | Acupuncturist | 600 Julian Lane, Suite 660, Arden, NC 28704 | 2013-06-10 |
1710288378 | Higher Ground Pediatric Therapy, Pllc | Community/Behavioral Health | 3749 Sweeten Creek Road Suites 1-2, Arden, NC 28704 | 2010-11-12 |
1962642868 | Pandora M Hodge | Physician Assistant | 436 Airport Road, Suite 20, Arden, NC 28704 | 2009-03-05 |
1710135009 | Wal-mart Stores, Inc. | Eyewear Supplier (Equipment, not the service) | 60 Airport Rd., Asheville, NC 28704 | 2008-08-29 |
1679732598 | Patty Ann Dalton | Social Worker | 126 Locust Court, Arden, NC 28704 | 2008-06-05 |
1053501783 | Roger A Wallace | Psychologist | 410 Mills Gap Rd., Arden, NC 28704 | 2007-07-30 |
Find all providers in zip 28704 |
Taxonomy Code | 207ND0101X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Dermatology |
Specialization | MOHS-Micrographic Surgery |
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942713052 | Vieta Dermatology, Pllc | Dermatology | 289 Olmsted Blvd Ste 5, Pinehurst, NC 28374-8730 | 2017-11-10 |
1245751403 | Bluewater Dermatology and Skin Cancer Center Pa | Dermatology | 814 Spivey Rd, Whiteville, NC 28472-8736 | 2017-06-28 |
1831330893 | Landon Everett Stigall | Dermatology | 6752 Rock Spring Rd Ste 201, Wilmington, NC 28405 | 2009-03-20 |
1780772541 | Jenny L. Stone | Dermatology | 203 Mocksville Ave Ste B, Salisbury, NC 28144-3360 | 2006-10-10 |
1528035722 | Marc Ronald Carruth | Dermatology | 2615 E 7th St, Charlotte, NC 28204-4376 | 2006-03-07 |
1508846403 | Rajat Varma | Dermatology | 410 Market St Ste 400, Unc Dept of Dermatology, Chapel Hill, NC 27516-4061 | 2006-01-18 |
1437130523 | Greg Edwin Viehman | Dermatology | 710 Military Cutoff Rd, Suite 200, Wilmington, NC 28405-2375 | 2005-11-07 |
1598759482 | Eastern Dermatology, P.a. | Dermatology | 420 Spring Forest Rd, Greenville, NC 27834-7244 | 2005-09-07 |
1285636076 | Charles S Johnson | Dermatology | 315 19th St Se, Hickory, NC 28602-4230 | 2005-08-11 |
1134123847 | Audrey F Echt | Dermatology | 10931 Raven Ridge Rd, Ste 101, Raleigh, NC 27614-6499 | 2005-06-09 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.