Provider Demographics
NPI:1316233992
Name:GORDON, SCOTT ROBERT (MT (AMT))
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ROBERT
Last Name:GORDON
Suffix:
Gender:M
Credentials:MT (AMT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MERLOT DR # 41
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-9551
Mailing Address - Country:US
Mailing Address - Phone:509-460-2947
Mailing Address - Fax:
Practice Address - Street 1:330 MERLOT DR # 41
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-9551
Practice Address - Country:US
Practice Address - Phone:509-460-2947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist