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General NPI Number Information
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NPI Number | 1184597544
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Entity Type | Individual
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Provider Name | TRAVIS DANIEL GORDON MD
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Gender | Male
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 4353 CLAYTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1621
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Country | US
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Telephone | 314-362-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 4591 MCREE AVE # 417
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2237
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Country | US
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Telephone | 604-968-6748
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Fax |
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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 | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | 2025027678
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License Number State | MO
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