Provider Demographics
NPI:1205039997
Name:GORDIAN, AMPARO LEILAH (MD)
Entity type:Individual
Prefix:
First Name:AMPARO
Middle Name:LEILAH
Last Name:GORDIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 MANATEE AVE W STE 201
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3859
Mailing Address - Country:US
Mailing Address - Phone:941-746-5200
Mailing Address - Fax:
Practice Address - Street 1:4900 MANATEE AVE W STE 201
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3859
Practice Address - Country:US
Practice Address - Phone:941-746-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL149438207RR0500X
MA239029207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026743AMedicaid
MA110026743AMedicaid