MEDICARE: DR. ROBERT M GORDON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician	J1041	TX
2	207RP1001X	Pulmonary Disease Physician	16378	OK
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	036166087	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5791345	OTHER	OK	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093701658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT M GORDON M.D.

Provider Business Mailing Address
First Line	:	4200 W MEMORIAL RD
Second Line	:	SUITE 805
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9350
Country	:	US
Telephone Number	:	405-286-5946
Fax Number	:	888-990-1791

Provider Business Practice Location Address
First Line	:	4200 W MEMORIAL RD
Second Line	:	SUITE 805
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9350
Country	:	US
Telephone Number	:	405-286-5946
Fax Number	:	888-990-1791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	05/20/2025

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Directions to “ DR. ROBERT M GORDON M.D.” Practice Location

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