Individual
DR. LAWRENCE W GORDON
Active
Individual
DR. LAWRENCE W GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
19749
TN
207WX0107X
Retina Specialist (Ophthalmology) Physician
19749
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119321
—
MS
05
—
146871001
—
AR
01
—
180031674
RAILROAD MEDICARE
TN
05
—
3050718
—
TN
01
—
3066300
BLUE CROSS OF TENNESSEE
TN
01
—
5L961
ARKANSAS MEDICARE
AR
01
—
P00777025
RAILROAD MEDICARE
AR
Enumeration date
06/17/2005
Last updated
04/26/2017
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