Provider Demographics
NPI:1265862023
Name:HART, GORDON (PA-C)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:HART
Suffix:
Gender:M
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 1:3351 W ROCK CREEK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2463
Mailing Address - Country:US
Mailing Address - Phone:405-928-4229
Mailing Address - Fax:
Practice Address - Street 1:3351 W ROCK CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2463
Practice Address - Country:US
Practice Address - Phone:405-928-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant