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Individual

SHAWN R GORDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
56 MARIE LANGDON DR, MANCHESTER, KY 40962-6329
(606) 599-4080
(606) 598-1688
Mailing address
509 MEMORIAL DR STE 2, MANCHESTER, KY 40962-6196
(606) 598-5104
(606) 598-0983

Taxonomy

Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
39057
KY
207V00000X
Obstetrics & Gynecology Physician
Primary
39057
KY
207V00000X
Obstetrics & Gynecology Physician
L3666
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11356327
CAQH ID
05
215019501
TX
05
2552545
OH
05
64091820
KY
Enumeration date
09/27/2006
Last updated
08/19/2024
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