Provider Demographics
NPI:1225086747
Name:HOLEN, GORDON NIEL (DO)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:NIEL
Last Name:HOLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 MIDDLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5014
Mailing Address - Country:US
Mailing Address - Phone:865-774-4440
Mailing Address - Fax:865-774-4868
Practice Address - Street 1:629 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5014
Practice Address - Country:US
Practice Address - Phone:865-774-4440
Practice Address - Fax:865-774-4868
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2957207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529874Medicaid
TN103I203555Medicare PIN