Individual
MRS. WENDY MICHELLE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSA
Contact information
Practice address
2600 SAINT MICHAEL DR, TEXARKANA, TX 75503-2372
(903) 614-1000
Mailing address
5403 WOODLINE DR, TEXARKANA, AR 71854-9236
(903) 293-4151
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
SA00281
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0055FL
BC/BS PROVIDER NUMBER
TX
Enumeration date
08/10/2006
Last updated
07/08/2007
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