Individual
O T GORDON JR.
Active
Individual
O T GORDON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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