Individual
GORDON S BRODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
811 W INTERSTATE 20, SUITE G22, ARLINGTON, TX 76017-5870
(817) 784-8268
(817) 276-1861
Mailing address
811 W INTERSTATE 20, SUITE G22, ARLINGTON, TX 76017-5870
(817) 784-8268
(817) 276-1861
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
E7839
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122740703
—
TX
05
—
122740704
—
TX
05
—
122740705
—
TX
01
—
122740706
MEDICAID OTHER
TX
05
—
122740707
—
TX
Enumeration date
09/26/2005
Last updated
05/23/2016
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