Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | TX1487 | TX |
Y | 222Z00000X | Podiatrist | TX1487 | TX |
N | 213ES0103X | Foot & Ankle Surgery | 1487 | TX |
NPI | 1073541819 |
---|---|
Provider Name | Dr. Michael Lawrence Gordon |
First Address | Houston, TX 77090-2697 |
Second Address | Houston, TX 77090-2697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 11/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043773302 | (05) | TX |
4344700001 | PALMETTO GBA (01) | TX |
480033891 | RAILROAD MEDICARE (01) | TX |
U79655 | (02) |