MEDICARE: DR. PAMELA K GORDON M.D.

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	207Q00000X	Family Medicine Physician	MD438281	PA
2	207Q00000X	Family Medicine Physician	15019	NV

General Provider Information

NPI Number	:	1124013206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA K GORDON M.D.

Provider Business Mailing Address
First Line	:	3901A SPICEWOOD SPRINGS RD STE 201
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8728
Country	:	US
Telephone Number	:	737-226-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 PLUMAS ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-4515
Country	:	US
Telephone Number	:	737-226-6700
Fax Number	:

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	10/18/2021

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