MEDICARE: DR. LEMUEL DURRELL GORDEN III 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	174400000X	Specialist	22077	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00159247	OTHER	GA	RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G54042	OTHER	AL	HEALTH SPRINGS
4	051521812	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1285630905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEMUEL DURRELL GORDEN III M.D.

Provider Business Mailing Address
First Line	:	225B WINTON M BLOUNT LOOP
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3507
Country	:	US
Telephone Number	:	334-263-6228
Fax Number	:	334-265-9136

Provider Business Practice Location Address
First Line	:	225B WINTON M BLOUNT LOOP
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3507
Country	:	US
Telephone Number	:	334-263-6228
Fax Number	:	334-265-9136

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	03/14/2024

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