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General NPI Number Information
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NPI Number | 1699838490
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Entity Type | Individual
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Provider Name | JAY M. GORDON R. N.
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6666 S SHERIDAN RD
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City | TULSA
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State | OK
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Zip | 74133-1756
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Country | US
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Telephone | 918-493-2727
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Fax | 918-493-2990
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Provider Business Mailing Address
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Address Line | 2809 E OAKRIDGE ST
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City | BROKEN ARROW
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State | OK
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Zip | 74014-5008
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Country | US
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Telephone | 918-258-8571
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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 | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | R0070280
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License Number State | OK
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