Provider Demographics
NPI:1740381052
Name:GORDON, STEVEN WITTENBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WITTENBERG
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12312 RUSSELL ST
Mailing Address - Street 2:STE 101
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2531
Mailing Address - Country:US
Mailing Address - Phone:913-787-5805
Mailing Address - Fax:913-730-8370
Practice Address - Street 1:12312 RUSSELL ST
Practice Address - Street 2:STE 101
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2531
Practice Address - Country:US
Practice Address - Phone:913-787-5805
Practice Address - Fax:913-730-8370
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS32351207Q00000X
MO2007001370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine