Healthcare Provider Details

I. General information

NPI: 1295776037
Provider Name (Legal Business Name): ERIC HOUSTON GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FAIR PARK BLVD
LITTLE ROCK AR
72204
US

IV. Provider business mailing address

800 FAIR PARK BLVD
LITTLE ROCK AR
72204
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-3647
  • Fax: 501-666-9653
Mailing address:
  • Phone: 501-663-3647
  • Fax: 501-666-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberE-4371
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: