Provider Demographics
NPI:1134238793
Name:BIRK, GORDON TROY (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:TROY
Last Name:BIRK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MALVERN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7759
Mailing Address - Country:US
Mailing Address - Phone:501-321-0555
Mailing Address - Fax:501-623-1521
Practice Address - Street 1:1900 MALVERN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7759
Practice Address - Country:US
Practice Address - Phone:501-321-0555
Practice Address - Fax:501-623-1521
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25289207XX0005X
ARE5044207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163783001Medicaid
AR5N807Medicare ID - Type UnspecifiedMC PROVIDER NUMBER
G33205Medicare UPIN