Provider Demographics
NPI:1730289802
Name:GORDON, LLOYD JAMES III (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:JAMES
Last Name:GORDON
Suffix:III
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 1:105 COLONY CROWN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8202
Mailing Address - Country:US
Mailing Address - Phone:601-829-3158
Mailing Address - Fax:601-829-9389
Practice Address - Street 1:3949 HIGHWAY 43 N
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7240
Practice Address - Country:US
Practice Address - Phone:601-829-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7875207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSD32838Medicare UPIN