Provider Demographics
NPI:1184620270
Name:GORDON, MARILYN SCHULZ (MD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:SCHULZ
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 W 4TH NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3813
Mailing Address - Country:US
Mailing Address - Phone:423-587-0067
Mailing Address - Fax:423-581-5882
Practice Address - Street 1:856 W 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3813
Practice Address - Country:US
Practice Address - Phone:423-587-0067
Practice Address - Fax:423-581-5882
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2011-10-03
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
TN019858207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0092751OtherBLUE CROSS/BLUE SHIELD
TN3047606Medicaid
TN3047606Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
TNE88683Medicare UPIN