Individual
SCOTT GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 S RITCHIE AVE, RAVENSWOOD, WV 26164-1721
(844) 291-4535
Mailing address
1300 W BELMONT AVE, STE 313, CHICAGO, IL 60657-3200
(773) 562-4973
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036093512
IL
2084P0800X
Psychiatry Physician
26351
WV
2084P0800X
Psychiatry Physician
54096
TN
2084P0800X
Psychiatry Physician
TM2015-0037
NM
Other
Enumeration date
06/07/2006
Last updated
09/26/2016
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