Provider Demographics
NPI:1972507366
Name:GORDON, BRET S (DO)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:S
Last Name:GORDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-7104
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:12330 METCALF AVE
Practice Address - Street 2:STE 420
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-323-9000
Practice Address - Fax:913-323-9001
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2018-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2001015997207V00000X
KS0530651207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209093103Medicaid
MO209093103Medicaid
MOI06874Medicare UPIN
MOK57C935Medicare ID - Type Unspecified