Provider Demographics
NPI:1023091071
Name:GORDON, DEBORAH (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1912 CHEROKEE AVE SW
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-5595
Mailing Address - Country:US
Mailing Address - Phone:256-739-8007
Mailing Address - Fax:256-739-8017
Practice Address - Street 1:503 CLARK ST NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-1921
Practice Address - Country:US
Practice Address - Phone:256-739-1759
Practice Address - Fax:256-739-0027
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL249402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009981665Medicaid
AL51000455OtherBCBS OF AL
ALG83943Medicare UPIN
AL009981665Medicaid