Individual
DR. KATHERINE E. GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
76 POLO RD, COLUMBIA, SC 29223-2806
(803) 699-7255
Mailing address
1910 GREGG STREET, COLUMBIA, SC 29201-2618
(803) 779-1420
(803) 931-0676
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2000-00804
NC
207Q00000X
Family Medicine Physician
Primary
20286
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12645
BCBS
NC
01
—
20286
SC LICENSE
SC
05
—
8912645
—
NC
01
—
99563
MEDCOST
—
01
—
P00399279
MEDICARE RAILROAD
—
Enumeration date
08/08/2006
Last updated
01/16/2024
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