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NPI Code Detail

MEDICARE: DR. ROBERT HALL GORDON PH.D.

MEDICARE: DR. ROBERT HALL GORDON PH.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
1103T00000XPsychologist36046TX
2103TC0700XClinical Psychologist2007012472MO

General Provider Information

NPI Number : 1417111568
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT HALL GORDON PH.D.
Provider Business Mailing Address
First Line : 1129 MACKLIND AVE
Second Line :
City : ST. LOUIS
State : MO
Zip : 63110-1440
Country : US
Telephone Number : 314-825-2161
Fax Number :
Provider Business Practice Location Address
First Line : 211 E 7TH ST STE 620
Second Line :
City : AUSTIN
State : TX
Zip : 78701-3218
Country : US
Telephone Number : 800-370-3651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2008
Last Update Date : 11/04/2021

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Directions to “ DR. ROBERT HALL GORDON PH.D.” Practice Location

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