Individual
O T GORDON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1609 W 40TH AVE, SUITE 312, PINE BLUFF, AR 71603-6329
(870) 534-3344
(870) 534-3517
Mailing address
1609 W 40TH AVE, SUITE 312, PINE BLUFF, AR 71603-6329
(870) 534-3344
(870) 534-3517
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
C5353
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03120019200
QUALCHOICE
AR
05
—
152438001
—
AR
01
—
2900041
UNITED HEALTH CARE
AR
01
—
4198220
AETNA
AR
01
—
5M782
BLUE CROSS BLUE SHIELD
AR
01
—
P00092540
RAIL ROAD MEDICARE
AR
Enumeration date
04/11/2006
Last updated
03/29/2010
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