Provider Demographics
NPI:1093007767
Name:GORDON, MATTHEW CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CRAIG
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:PO BOX 1798
Mailing Address - Street 2:DEPT: 07-0079
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101
Mailing Address - Country:US
Mailing Address - Phone:901-759-2322
Mailing Address - Fax:901-759-2077
Practice Address - Street 1:7658 POPLAR PIKE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-759-2322
Practice Address - Fax:901-759-2077
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME113912207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program