Basic Information
| Provider Information | |||||||||
| NPI: | 1588101000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5151 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146458300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5151 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146455555 | ||||||||
| FaxNumber: | 2146454446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2017 | ||||||||
| LastUpdateDate: | 01/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.