Individual
DR. JENNIFER ROSE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5301 DAVIS LN STE 100, AUSTIN, TX 78749-4061
(512) 615-2730
(512) 566-3612
Mailing address
5301 DAVIS LN STE 100, AUSTIN, TX 78749-4061
(512) 615-2730
(512) 666-3764
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
P5367
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8EK794
BCBS PROVIDER RECORD ID
TX
Enumeration date
05/18/2009
Last updated
02/06/2019
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