Provider Demographics
NPI:1275780009
Name:GORDON, WILLIAM LEE JR (RN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEE
Last Name:GORDON
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 S STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-1713
Mailing Address - Country:US
Mailing Address - Phone:520-622-8030
Mailing Address - Fax:
Practice Address - Street 1:2435 N CASTRO AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5060
Practice Address - Country:US
Practice Address - Phone:520-622-8030
Practice Address - Fax:520-622-9159
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3107363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health