Healthcare Provider Details

I. General information

NPI: 1386621118
Provider Name (Legal Business Name): SARAH L. GORDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. SARAH GORDON TEMPLEMIRE

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 W CLAY RD
VERSAILLES MO
65084
US

IV. Provider business mailing address

821 WESTWOOD DR
SEDALIA MO
65301-2102
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-2349
  • Fax: 888-979-8868
Mailing address:
  • Phone: 660-826-4774
  • Fax: 660-827-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2001006974
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: