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General NPI Number Information
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NPI Number | 1740466200
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Entity Type | Organization
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Legal Business Name | MINOR W GORDON PH D PC
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 3223 E 31ST ST
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City | TULSA
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State | OK
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Zip | 74105-2452
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Country | US
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Telephone | 918-747-5308
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Fax |
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Provider Business Mailing Address
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Address Line | 3223 E 31ST ST
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City | TULSA
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State | OK
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Zip | 74105-2452
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Country | US
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Telephone | 918-747-5308
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MINOR WILLIAM GORDON
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Credential | PH D
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Telephone | 918-747-5308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 309
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License Number State | OK
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