Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | D0889 | TX |
NPI | 1013186188 |
---|---|
Provider Name | Dr. Fallon Turley Gordon SR. |
First Address | Beaumont, TX 77706-7600 |
Second Address | Beaumont, TX 77706-7600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2008 |
Last Update Date | 22/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B87909 | (02) | TX |