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Individual

DR. LAWRENCE W GORDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6005 PARK AVE, STE 624B, MEMPHIS, TN 38119-5221
(901) 682-1100
(901) 682-6915
Mailing address
PO BOX 1000 DEPT 448, MEMPHIS, TN 38148-0448
(901) 682-1100
(901) 682-6915

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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