Provider Demographics
NPI:1750409629
Name:GORDON, MARK A (PA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:GORDON
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:619 ROLLING BROOK DR
Mailing Address - Street 2:#211
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:817-506-0580
Mailing Address - Fax:
Practice Address - Street 1:13601 WOOD FOREST BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015
Practice Address - Country:US
Practice Address - Phone:713-330-4325
Practice Address - Fax:713-330-1910
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant