Healthcare Provider Details

I. General information

NPI: 1588101000
Provider Name (Legal Business Name): ANN MARIE GORDON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2017
Last Update Date: 01/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 HARRY HINES BLVD
DALLAS TX
75235-7707
US

IV. Provider business mailing address

5151 HARRY HINES BLVD
DALLAS TX
75235-7707
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-5555
  • Fax: 214-645-4446
Mailing address:
  • Phone: 214-645-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: