Individual
MR. LUCIUS NMN GORDON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5640 S 3500 W, ROY, UT 84067-9158
(801) 773-2838
(801) 773-3025
Mailing address
1055 N 500 W ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10495233-1206
UT
363A00000X
Physician Assistant
—
—
Other
Enumeration date
11/07/2006
Last updated
03/17/2018
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