Provider Demographics
NPI:1558389288
Name:GORDON, JOE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:E
Last Name:GORDON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6062
Mailing Address - Fax:314-454-5054
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:STE 1B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6062
Practice Address - Fax:314-454-5054
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-04-25
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Provider Licenses
StateLicense IDTaxonomies
MO103144207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206998601Medicaid
MO206998601Medicaid
MO200022728Medicare PIN
MO053010232Medicaid