Provider Demographics
NPI:1962466862
Name:GORDON, KARA L (DPM, MBA)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:L
Last Name:GORDON
Suffix:
Gender:F
Credentials:DPM, MBA
Other - Prefix:DR
Other - First Name:KARA
Other - Middle Name:L
Other - Last Name:MONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10524 E HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-8371
Mailing Address - Country:US
Mailing Address - Phone:520-459-3339
Mailing Address - Fax:520-459-3342
Practice Address - Street 1:10524 E HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-8371
Practice Address - Country:US
Practice Address - Phone:520-459-3339
Practice Address - Fax:520-459-3342
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0553213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ642662Medicaid
7253307OtherAETNA
5591608001OtherCIGNA
AZAZ0194810OtherBCBS OF AZ
P00005439Medicare ID - Type UnspecifiedMEDICARE RAILROAD
7253307OtherAETNA
AZ642662Medicaid
4817890001Medicare NSC