Provider Demographics
NPI:1124048343
Name:GORDON, ASHLEY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W 38TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1163
Mailing Address - Country:US
Mailing Address - Phone:512-371-8817
Mailing Address - Fax:512-371-8819
Practice Address - Street 1:901 W 38TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1163
Practice Address - Country:US
Practice Address - Phone:512-371-8817
Practice Address - Fax:512-371-8819
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051940208200000X
TXM4110208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery