Organization
CTVHS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE GORDON M.D (STAFF PHYSICIAN)
(254) 743-2300
Entity
Organization
Contact information
Practice address
1901 S 1ST ST, 111 GM-T, TEMPLE, TX 76504-7451
(254) 743-2300
Mailing address
1901 S 1ST ST, 111 GM-T, TEMPLE, TX 76504-7451
(254) 743-2300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
023405
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023405
STATE LICENSE NUMBER
LA
Enumeration date
08/10/2006
Last updated
08/22/2020
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