Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0519181 | KS |
N | 207V00000X | Obstetrician & Gynecologist | R9794 | MO |
NPI | 1023012523 |
---|---|
Provider Name | Stephen M Gordon |
First Address | Overland Park, KS 66213-1324 |
Second Address | Overland Park, KS 66213-1324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 09/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
241356849 | (05) | MO |
C50876 | (02) | MO |