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NPI Code Detail

MEDICARE: DR. TRACY A GORDON M.D.

MEDICARE: DR. TRACY A 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
1207L00000XAnesthesiology Physician97-63NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2NM009V08OTHERNMBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1942204763
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACY A GORDON M.D.
Provider Business Mailing Address
First Line : 1720 LOUISIANA BLVD NE
Second Line : STE 401
City : ALBUQUERQUE
State : NM
Zip : 87110-7020
Country : US
Telephone Number : 505-260-4300
Fax Number : 505-260-4338
Provider Business Practice Location Address
First Line : 1205 S TELSHOR BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-4748
Country : US
Telephone Number : 505-260-4300
Fax Number : 505-260-4338
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 07/09/2007

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