Healthcare Provider Details

I. General information

NPI: 1093701658
Provider Name (Legal Business Name): ROBERT M GORDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W MEMORIAL RD SUITE 805
OKLAHOMA CITY OK
73120-9350
US

IV. Provider business mailing address

4200 W MEMORIAL RD SUITE 805
OKLAHOMA CITY OK
73120-9350
US

V. Phone/Fax

Practice location:
  • Phone: 405-286-5946
  • Fax: 888-990-1791
Mailing address:
  • Phone: 405-286-5946
  • Fax: 888-990-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberJ1041
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number16378
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036166087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: