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
1	208600000X	Surgery Physician	13013R	LA

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	:	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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