Healthcare Provider Details

I. General information

NPI: 1639192297
Provider Name (Legal Business Name): MARY E GORDINIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3991 DUTCHMANS LN STE 405
LOUISVILLE KY
40207-4723
US

IV. Provider business mailing address

PO BOX 776347
CHICAGO IL
60677-6347
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-3366
  • Fax: 502-899-6686
Mailing address:
  • Phone: 502-272-5052
  • Fax: 502-629-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number39607
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: