Individual
DR. GLENN L GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
036067470
IL
207RG0100X
Gastroenterology Physician
Primary
R1H39
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010137
MEDICARE #
MO
01
—
R1H39
MISSOURI LICENSE NUMBER
MO
Enumeration date
07/19/2006
Last updated
10/28/2020
Update your record
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