Provider Demographics
NPI:1447228549
Name:GORDON, ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 S WHEELING AVE
Mailing Address - Street 2:STE 404
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5633
Mailing Address - Country:US
Mailing Address - Phone:918-748-7640
Mailing Address - Fax:918-403-6317
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:STE 404
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-748-7640
Practice Address - Fax:918-403-6317
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100113490AMedicaid
OKG04101Medicare UPIN