Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4212 | IA |
Y | 2080P0203X | Pediatric Critical Care Doctor | Q0921 | TX |
NPI | 1043471030 |
---|---|
Provider Name | Erin Eileen Gordon |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 25/09/2014 |