Provider Demographics
NPI:1710913785
Name:BARTH, GORDON (DO)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:
Last Name:BARTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 N RIEDEL ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78164-1810
Mailing Address - Country:US
Mailing Address - Phone:361-564-3383
Mailing Address - Fax:361-564-4224
Practice Address - Street 1:508 N RIEDEL ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:TX
Practice Address - Zip Code:78164-1810
Practice Address - Country:US
Practice Address - Phone:361-564-3383
Practice Address - Fax:361-564-4224
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P9303OtherBLUE CROSS BLUE SHIELD OF
TX170895010Medicaid
D97193Medicare UPIN
TX8D9319Medicare ID - Type Unspecified