Organization
GORDLEY PLASTIC SURGERY PA
Active
Other names
KYLE P GORDLEY MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE PATRICK GORDLEY M.D. (M.D./OWNER)
(832) 813-5839
Entity
Organization
Contact information
Practice address
129 VISION PARK BLVD STE 210, SHENANDOAH, TX 77384-3024
(832) 813-5839
(832) 813-8512
Mailing address
129 VISION PARK BLVD STE 210, SHENANDOAH, TX 77384-3024
(832) 813-5839
(832) 813-8512
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
M7222
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
336661901
—
TX
01
—
DP0233
RR MC PIN
TX
Enumeration date
03/19/2008
Last updated
08/11/2020
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