MEDICARE: DR. CHRISTOPHER GORDON D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	11021602-1204	UT
2	207K00000X	Allergy & Immunology Physician	110216021204	UT

General Provider Information

NPI Number	:	1003234873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER GORDON D.O.

Provider Business Mailing Address
First Line	:	745 N 500 W STE 200
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-1472
Country	:	US
Telephone Number	:	801-375-9292
Fax Number	:	801-375-9290

Provider Business Practice Location Address
First Line	:	745 N 500 W STE 200
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-1472
Country	:	US
Telephone Number	:	801-375-9292
Fax Number	:	801-375-9290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	01/13/2025

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