MEDICARE: DAVID LEE 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	2084N0400X	Neurology Physician	ME80255	FL
2	2084N0400X	Neurology Physician	25434	OK
3	2084V0102X	Vascular Neurology Physician	ME80255	FL
4	2084V0102X	Vascular Neurology Physician	25434	OK

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	:	1376500223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LEE GORDON M.D.

Provider Business Mailing Address
First Line	:	711 STANTON L YOUNG BLVD
Second Line	:	SUITE 215
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104
Country	:	US
Telephone Number	:	405-271-4113
Fax Number	:	405-271-5723

Provider Business Practice Location Address
First Line	:	711 STANTON L YOUNG BLVD
Second Line	:	SUITE 210
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5021
Country	:	US
Telephone Number	:	405-271-3635
Fax Number	:	405-271-2523

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	01/24/2011

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Directions to “ DAVID LEE GORDON M.D.” Practice Location

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