Individual
JOHNATHAN PAUL GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 N FAIRLAND ST, PRYOR, OK 74361-4203
(918) 825-1405
(918) 876-3436
Mailing address
109 N FAIRLAND ST, PRYOR, OK 74361-4203
(918) 825-1405
(918) 876-3436
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6386
OK
Other
Enumeration date
09/10/2018
Last updated
11/13/2020
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