Provider Demographics
NPI:1194816751
Name:ALCOX, GORDON KEITH (MD)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:KEITH
Last Name:ALCOX
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 1:304 UNIVERSITY AVE SUITE 201
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5247
Mailing Address - Country:US
Mailing Address - Phone:903-935-7708
Mailing Address - Fax:903-935-6248
Practice Address - Street 1:304 UNIVERSITY AVE SUITE 201
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5247
Practice Address - Country:US
Practice Address - Phone:903-935-7708
Practice Address - Fax:903-935-6248
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7405208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035557001Medicaid
TX020026756OtherMEDICARE RAILROAD RETIRE
TX035557001Medicaid
TX020026756OtherMEDICARE RAILROAD RETIRE