Organization
CHARLES R GORDON MD PA
Active
Other names
Precision Spine Care
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES R GORDON M.D. (PRESIDENT)
(903) 592-6000
Entity
Organization
Contact information
Practice address
2737 S BROADWAY AVE STE 200, TYLER, TX 75701-5445
(903) 592-6000
(903) 595-1592
Mailing address
PO BOX 6605, TYLER, TX 75711-6605
(903) 592-6000
(903) 595-1592
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207T00000X
Neurological Surgery Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0023KV
BLUE CROSS BLUE SHIELD
—
05
—
163108701
—
TX
Enumeration date
08/16/2006
Last updated
03/10/2020
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