Healthcare Provider Details

I. General information

NPI: 1972557585
Provider Name (Legal Business Name): RICHARD ALLEN GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 S LEWIS AVE
TULSA OK
74136-6836
US

IV. Provider business mailing address

7600 S LEWIS AVE
TULSA OK
74136-6836
US

V. Phone/Fax

Practice location:
  • Phone: 918-493-2229
  • Fax: 918-493-7819
Mailing address:
  • Phone: 918-493-2229
  • Fax: 918-493-7819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11805
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: