Healthcare Provider Details

I. General information

NPI: 1972507366
Provider Name (Legal Business Name): BRET S GORDON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12330 METCALF AVE STE 420
OVERLAND PARK KS
66213-1324
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400N
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 913-323-9000
  • Fax: 913-323-9001
Mailing address:
  • Phone: 816-502-7104
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2001015997
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0530651
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: