MEDICARE: DR. VERLEY 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	208000000X	Pediatrics Physician	J-9062	TX

General Provider Information

NPI Number	:	1528172665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VERLEY GORDON M.D.

Provider Business Mailing Address
First Line	:	1700 E MILE 3 RD
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78573-8302
Country	:	US
Telephone Number	:	956-519-3166
Fax Number	:	956-519-3166

Provider Business Practice Location Address
First Line	:	5711 N. LA HOMA RD
Second Line	:	STE. B
City	:	MISSION
State	:	TX
Zip	:	78574
Country	:	US
Telephone Number	:	956-424-9050
Fax Number	:	956-424-9050

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	12/30/2024

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