MEDICARE: DR. BARRY EDMUND 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	208800000X	Urology Physician	23608	AZ

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	:	1821074048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY EDMUND GORDON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6423
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85246-6423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 E GUADALUPE RD
Second Line	:	#102
City	:	GILBERT
State	:	AZ
Zip	:	85234-5116
Country	:	US
Telephone Number	:	480-539-8300
Fax Number	:	480-539-8311

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	11/17/2022

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Directions to “ DR. BARRY EDMUND GORDON M.D.” Practice Location

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