Provider Demographics
NPI:1528172665
Name:GORDON, VERLEY (MD)
Entity type:Individual
Prefix:DR
First Name:VERLEY
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E MILE 3 RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-8302
Mailing Address - Country:US
Mailing Address - Phone:956-519-3166
Mailing Address - Fax:956-519-3166
Practice Address - Street 1:5711 N. LA HOMA RD
Practice Address - Street 2:STE. B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574
Practice Address - Country:US
Practice Address - Phone:956-424-9050
Practice Address - Fax:956-424-9050
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ-9062208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG17193Medicare UPIN