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General NPI Number Information
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NPI Number | 1164426193
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Entity Type | Individual
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Provider Name | KRISTA GORDON MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 5366 NW CACHE RD STE 6
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City | LAWTON
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State | OK
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Zip | 73505-3353
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Country | US
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Telephone | 580-536-7546
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Fax | 580-581-2051
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Provider Business Mailing Address
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Address Line | 5366 NW CACHE RD STE 6
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City | LAWTON
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State | OK
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Zip | 73505-3353
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Country | US
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Telephone | 580-536-7546
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Fax | 580-581-2051
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21237
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License Number State | OK
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