Healthcare Provider Details

I. General information

NPI: 1952841355
Provider Name (Legal Business Name): MORGAN RAEANN GORDON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 01/25/2022
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 5TH ST
RACINE OH
45771-5012
US

IV. Provider business mailing address

207 5TH ST
RACINE OH
45771-5012
US

V. Phone/Fax

Practice location:
  • Phone: 740-949-2683
  • Fax: 740-949-2462
Mailing address:
  • Phone: 740-949-2683
  • Fax: 740-949-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.014201
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: