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Individual

DR. GARY G. GORDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-9265
(601) 703-9401
Mailing address
1800 12TH ST, MERIDIAN, MS 39301-4158
(601) 703-9265
(601) 703-9936

Taxonomy

Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
07448
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000039981
MEDICAID OF AL
AL
01
0130017
UNITED HEALTH CARE
MS
05
04458061
MS
01
080030813
RAILROAD MEDICARE
01
73003105
BLUE CROSS OF AL
AL
Enumeration date
08/19/2005
Last updated
11/06/2013
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