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NPI Code Detail

MEDICARE: DR. GREGORY ANDREW GORDON M.D.

MEDICARE: DR. GREGORY ANDREW 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
12084P0800XPsychiatry Physician16391MS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3260044396OTHERMSRAILROAD MEDICARE
4P00657494OTHERMSMEDICARE RR

Other Identifiers

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

General Provider Information

NPI Number : 1639105794
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY ANDREW GORDON M.D.
Provider Business Mailing Address
First Line : 232 MARKET ST
Second Line : SUITE 234
City : FLOWOOD
State : MS
Zip : 39232-3339
Country : US
Telephone Number : 601-214-3539
Fax Number : 601-914-7201
Provider Business Practice Location Address
First Line : 232 MARKET ST
Second Line : SUITE 234
City : FLOWOOD
State : MS
Zip : 39232-3339
Country : US
Telephone Number : 601-214-3539
Fax Number : 601-914-7201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 11/02/2016

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