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NPI Code Detail

MEDICARE: ISIS GORDON

MEDICARE: ISIS GORDON
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
1390200000XStudent in an Organized Health Care Education/Training ProgramTX

General Provider Information

NPI Number : 1124968052
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISIS GORDON
Provider Business Mailing Address
First Line : 701 W 5TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79763-4206
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 701 W 5TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79763-4206
Country : US
Telephone Number : 432-703-5238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2026
Last Update Date : 03/31/2026

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Directions to “ ISIS GORDON ” Practice Location

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