Healthcare Provider Details

I. General information

NPI: 1881610780
Provider Name (Legal Business Name): ELIZABETH GORDON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 SOUTH PEAKWOOD
KATY TX
77450
US

IV. Provider business mailing address

P.O. BOX 4346 DEPT 578
HOUSTON TX
77210
US

V. Phone/Fax

Practice location:
  • Phone: 281-395-5437
  • Fax:
Mailing address:
  • Phone: 713-850-1190
  • Fax: 713-850-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH GORDON
Title or Position: DIRECTOR
Credential: MD
Phone: 281-955-5437