Provider Demographics
NPI:1750320453
Name:GORDON, TIMOTHY E (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:GORDON
Suffix:
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 1:1050 N JAMES CAMPBELL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2754
Mailing Address - Country:US
Mailing Address - Phone:931-375-1050
Mailing Address - Fax:931-380-9269
Practice Address - Street 1:1050 N JAMES CAMPBELL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2754
Practice Address - Country:US
Practice Address - Phone:931-375-1050
Practice Address - Fax:931-380-9269
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN16081207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN86394OtherBCBS
TN86394OtherBCBS
TNA97761Medicare UPIN