MEDICARE: ELIZABETH A 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	208000000X	Pediatrics Physician	K4070	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265436984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A GORDON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 650859
Second Line	:	DEPT 710
City	:	DALLAS
State	:	TX
Zip	:	75265
Country	:	US
Telephone Number	:	409-772-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 E HOSPITAL DR STE 106
Second Line	:
City	:	ANGLETON
State	:	TX
Zip	:	77515-4170
Country	:	US
Telephone Number	:	979-864-3034
Fax Number	:

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	02/28/2023

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