Provider Demographics
NPI:1457374886
Name:DORRIS, GORDON GRAY
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:GRAY
Last Name:DORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12122 CHICAMAUGA TRL SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2243
Mailing Address - Country:US
Mailing Address - Phone:256-882-6689
Mailing Address - Fax:
Practice Address - Street 1:8075 MADISON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2041
Practice Address - Country:US
Practice Address - Phone:256-772-6220
Practice Address - Fax:256-461-0030
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine