Provider Demographics
NPI:1649469933
Name:GORDON B. STROM,JR. MD FACP
Entity type:Organization
Organization Name:GORDON B. STROM,JR. MD FACP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:B
Authorized Official - Last Name:STROM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:903-785-8480
Mailing Address - Street 1:2850 LEWIS LN
Mailing Address - Street 2:STE. 111
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9378
Mailing Address - Country:US
Mailing Address - Phone:903-785-8480
Mailing Address - Fax:903-785-8455
Practice Address - Street 1:2850 LEWIS LN
Practice Address - Street 2:STE. 111
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9378
Practice Address - Country:US
Practice Address - Phone:903-785-8480
Practice Address - Fax:903-785-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0027207KI0005X, 207RA0201X, 207R00000X
TXPA030704363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Multi-Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCK8750OtherMEDICARE RAILROAD
OK100071470AMedicaid
TX00TU80OtherBLUE CROSS BLUE SHIELD
TX160367201Medicaid
TX00TU80OtherBLUE CROSS BLUE SHIELD
TX160367201Medicaid