Provider Demographics
NPI:1427079243
Name:GORDON, DAVID H (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:540 MADISON OAK DR
Mailing Address - Street 2:SUITE#200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3943
Mailing Address - Country:US
Mailing Address - Phone:210-545-6972
Mailing Address - Fax:210-545-1016
Practice Address - Street 1:540 MADISON OAK DR
Practice Address - Street 2:SUITE#200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3943
Practice Address - Country:US
Practice Address - Phone:210-545-6972
Practice Address - Fax:210-545-1016
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE9664207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4273192OtherAETNA PPO
924685OtherAETNA HMO
TX129531303Medicaid
TX830041663OtherRAILROAD MEDICARE
TX83Z201OtherBLUE CROSS/BLUE SHIELD OF
TX83Z201OtherBLUE CROSS/BLUE SHIELD OF
4273192OtherAETNA PPO