Provider Demographics
NPI:1760191704
Name:GORDON, ORA
Entity Type:Individual
Prefix:
First Name:ORA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8925
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77249-8925
Mailing Address - Country:US
Mailing Address - Phone:832-814-5032
Mailing Address - Fax:
Practice Address - Street 1:12712 W LAKE HOUSTON PKWY STE B-4056
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-6467
Practice Address - Country:US
Practice Address - Phone:281-205-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator