Provider Demographics
NPI:1609026087
Name:STEPHEN V. GORDON MD LLC
Entity Type:Organization
Organization Name:STEPHEN V. GORDON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-769-6400
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 5004
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-769-6400
Mailing Address - Fax:225-769-6404
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 5004
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-769-6400
Practice Address - Fax:225-769-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2020-12-03
Deactivation Date:2020-09-25
Deactivation Code:
Reactivation Date:2020-12-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty