Individual
DR. GLENN L GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
714 MEDICAL PARK DR, MEXICO, MO 65265-3726
(573) 590-1553
(877) 958-7717
Mailing address
714 MEDICAL PARK DR, MEXICO, MO 65265-3726
(573) 590-1553
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
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