Individual
OTIS T GORDON
Active
Individual
OTIS T GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
E-4082
AR
207RG0100X
Gastroenterology Physician
E4082
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5N145
BLUE CROSS BLUE SHIELD
AR
Enumeration date
04/13/2006
Last updated
07/21/2025
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