Provider Demographics
NPI:1770043317
Name:CHRISTOPHER GORDON DO, LLC
Entity Type:Organization
Organization Name:CHRISTOPHER GORDON DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-616-1396
Mailing Address - Street 1:745 N 500 W STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1472
Mailing Address - Country:US
Mailing Address - Phone:801-375-9292
Mailing Address - Fax:801-375-9290
Practice Address - Street 1:745 N 500 W STE 200
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1472
Practice Address - Country:US
Practice Address - Phone:801-375-9292
Practice Address - Fax:801-375-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty