Provider Demographics
NPI:1588101000
Name:GORDON, ANN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:GORDON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7707
Mailing Address - Country:US
Mailing Address - Phone:214-645-8300
Mailing Address - Fax:
Practice Address - Street 1:5151 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7707
Practice Address - Country:US
Practice Address - Phone:214-645-5555
Practice Address - Fax:214-645-4446
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical