Provider Demographics
NPI:1427102821
Name:GORDON, GREGORY D JR (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:GORDON
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24165 IH 10 W STE 123
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1160
Mailing Address - Country:US
Mailing Address - Phone:210-390-0008
Mailing Address - Fax:888-842-4234
Practice Address - Street 1:24165 IH 10 W STE 123
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1160
Practice Address - Country:US
Practice Address - Phone:210-390-0008
Practice Address - Fax:888-842-4234
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8702207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427102821OtherNPI
TX1780897306OtherGROUP NPI
TX8K2343Medicare PIN