Individual
GAYLE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2909 MILITARY RD, BENTON, AR 72015-2721
(501) 778-4674
(501) 778-4694
Mailing address
2909 MILITARY RD, BENTON, AR 72015-2721
(501) 778-4674
(501) 778-4694
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
E-1397
AR
207Q00000X
Family Medicine Physician
E-1397
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132153001
—
AR
01
—
5K572
AR BCBS
AR
Enumeration date
07/11/2006
Last updated
07/03/2008
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