# SHAWN GORDEN MD PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356489652
- **Authorized official:** DR. SHAWN GORDEN MD (PRES)
- **Authorized official phone:** (606) 326-0024

## Contact information

- **Practice address:** 617 23RD ST, STE 6, ASHLAND, KY 41101-2845
- **Practice address phone:** (606) 326-0024
- **Practice address fax:** (606) 326-0041
- **Mailing address:** 617 23RD ST, STE 6, ASHLAND, KY 41101-2845
- **Mailing address phone:** (606) 326-0024
- **Mailing address fax:** (606) 326-0041

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 39057 | KY | Yes |

## Other

- **Enumeration date:** 02/01/2007
- **Last updated:** 06/26/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 64091820 | — | KY |