Healthcare Provider Details

I. General information

NPI: 1477512820
Provider Name (Legal Business Name): GORDON URETSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WILSON ST
HENDERSON TX
75652-5956
US

IV. Provider business mailing address

300 WILSON ST
HENDERSON TX
75652-5956
US

V. Phone/Fax

Practice location:
  • Phone: 903-655-6536
  • Fax: 903-657-6072
Mailing address:
  • Phone: 903-655-6536
  • Fax: 903-657-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG0226
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: