Provider Demographics
NPI:1588829717
Name:DR. LORI L. GORDON, PLLC
Entity Type:Organization
Organization Name:DR. LORI L. GORDON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-545-2610
Mailing Address - Street 1:1900 W CHANDLER BLVD # 15-437
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8632
Mailing Address - Country:US
Mailing Address - Phone:480-237-9953
Mailing Address - Fax:480-237-9953
Practice Address - Street 1:595 N DOBSON RD STE A5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3404
Practice Address - Country:US
Practice Address - Phone:480-237-9954
Practice Address - Fax:480-237-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy