MEDICARE: DR. ALEXIA L 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	18945	SC

General Provider Information

NPI Number	:	1285698092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIA L GORDON M.D.

Provider Business Mailing Address
First Line	:	1800 MAIN ST
Second Line	:	#415
City	:	DALLAS
State	:	TX
Zip	:	75201-5202
Country	:	US
Telephone Number	:
Fax Number	:	803-730-5207

Provider Business Practice Location Address
First Line	:	207 S HOUSTON ST
Second Line	:	SUITE 400
City	:	DALLAS
State	:	TX
Zip	:	75202-4790
Country	:	US
Telephone Number	:	214-655-3200
Fax Number	:	214-655-3213

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	02/07/2014

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