Provider Demographics
NPI:1417210212
Name:JONES, GORDON WILLIAM SR (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:WILLIAM
Last Name:JONES
Suffix:SR
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 1:1749 OLD FM 705
Mailing Address - Street 2:
Mailing Address - City:BROADDUS
Mailing Address - State:TX
Mailing Address - Zip Code:75929-1749
Mailing Address - Country:US
Mailing Address - Phone:409-584-2282
Mailing Address - Fax:
Practice Address - Street 1:1749 OLD FM 705
Practice Address - Street 2:
Practice Address - City:BROADDUS
Practice Address - State:TX
Practice Address - Zip Code:75929-1749
Practice Address - Country:US
Practice Address - Phone:409-584-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC5740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine