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General NPI Number Information
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NPI Number | 1144694902
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Entity Type | Organization
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Legal Business Name | CHARLES R. GORDON MD PA
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 1802 MOORES LN
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City | TEXARKANA
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State | TX
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Zip | 75503-4609
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Country | US
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Telephone | 903-306-0711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6605
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City | TYLER
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State | TX
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Zip | 75711-6605
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Country | US
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Telephone | 903-363-1550
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Fax | 903-595-1592
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES R GORDON
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Credential | M.D.
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Telephone | 903-363-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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