Individual
LORI LYNN GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1420 8TH AVENUE, SUITE 103, FORT WORTH, TX 76104-4138
(817) 924-9002
(817) 924-9960
Mailing address
P. O. BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 924-9960
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
J6468
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213903201
—
TX
Enumeration date
02/22/2006
Last updated
09/30/2011
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