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NPI Code Detail

MEDICARE: DR. STEPHEN V GORDON MD

MEDICARE: DR. STEPHEN V GORDON MD
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
1208600000XSurgery Physician13013RLA

Other Identifiers

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

General Provider Information

NPI Number : 1912908518
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN V GORDON MD
Provider Business Mailing Address
First Line : 8490 PICARDY AVE
Second Line : BUILDING 600, SUITE B
City : BATON ROUGE
State : LA
Zip : 70809
Country : US
Telephone Number : 225-769-6400
Fax Number : 225-763-4598
Provider Business Practice Location Address
First Line : 8490 PICARDY AVE
Second Line : BUILDING 600, SUITE B
City : BATON ROUGE
State : LA
Zip : 70809
Country : US
Telephone Number : 225-769-6400
Fax Number : 225-763-4598
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 09/25/2020

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