Individual
MR. ANTHONY DESHAWN GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5205 NW 111TH ST, OKLAHOMA CITY, OK 73162-5908
(405) 822-0079
Mailing address
5205 NW 111TH ST, OKLAHOMA CITY, OK 73162-5908
(405) 822-0079
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/25/2013
Last updated
11/25/2013
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