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Individual

IAN GORDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
4120 W MEMORIAL RD, SUITE 300, OKLAHOMA CITY, OK 73120-9320
(405) 748-3300
(405) 749-1671
Mailing address
4120 W MEMORIAL RD, SUITE 300, OKLAHOMA CITY, OK 73120-9320
(405) 748-3300
(405) 749-1671

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2358
OK
363AM0700X
Medical Physician Assistant
2358
OK
363AS0400X
Surgical Physician Assistant
Primary
2358
OK

Other

Enumeration date
01/30/2014
Last updated
06/12/2015
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