Individual
DR. ELY R GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, MPH
Contact information
Practice address
500 BROOKSIDE DRIVE, PO BOX 847, MADILL, OK 73446-0847
(580) 795-5506
(580) 795-5145
Mailing address
5012 S US HWY 75, SUITE 300, ATTN BILLING, DENISON, TX 75020-4589
(580) 795-5506
(580) 795-5145
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2006023036
MO
207R00000X
Internal Medicine Physician
DO 621
AL
208000000X
Pediatrics Physician
2006023036
MO
208000000X
Pediatrics Physician
DO 621
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000008373
—
AL
01
—
0411221
UNITED HEALTHCARE
—
01
—
110187817
RR MEDICARE
—
01
—
51008373
BCBS
—
Enumeration date
04/18/2006
Last updated
03/17/2018
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