Individual
JEFFERY D GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 N KENTUCKY AVE, WEST PLAINS, MO 65775-2029
(417) 257-6713
(417) 257-5878
Mailing address
PO BOX 1100, WEST PLAINS, MO 65775-1100
(417) 256-9111
(417) 257-5947
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
45986
MN
2085R0202X
Diagnostic Radiology Physician
2017001081
MO
2085R0202X
Diagnostic Radiology Physician
Primary
45986
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
098444200
—
MN
05
—
1477531838
—
MO
05
—
218633001
—
AR
Enumeration date
01/05/2006
Last updated
09/25/2024
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