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General NPI Number Information
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NPI Number | 1144731464
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Entity Type | Organization
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Legal Business Name | HEART HEALTH CLINIC PLLC
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Dates
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Enumeration Date | 10/13/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 808 WOODROW WILSON RAY CIR
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City | BRIDGEPORT
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State | TX
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Zip | 76426-2061
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Country | US
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Telephone | 469-908-0400
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Fax | 469-908-0401
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Provider Business Mailing Address
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Address Line | 3409 RAMBLING WAY
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City | PLANO
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State | TX
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Zip | 75093-7601
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Country | US
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Telephone | 469-908-0400
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Fax | 469-908-0401
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE MICHAEL GORDON
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Credential | DO
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Telephone | 469-908-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | K5967
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License Number State | TX
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