Provider Demographics
NPI:1386169936
Name:VERLEY GORDON M.D., P.A.
Entity type:Organization
Organization Name:VERLEY GORDON M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-424-9050
Mailing Address - Street 1:5711 N LA HOMA RD STE B
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-5776
Mailing Address - Country:US
Mailing Address - Phone:956-424-9050
Mailing Address - Fax:959-424-0951
Practice Address - Street 1:5711 N LA HOMA RD STE B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-5776
Practice Address - Country:US
Practice Address - Phone:956-424-9050
Practice Address - Fax:959-424-0951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9062261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid