Provider Demographics
NPI:1770586919
Name:GORDON, JEFFERY S (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:S
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2855
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:1300 SAWGRASS CORPORATE PARKWAY
Practice Address - Street 2:STE 200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2823
Practice Address - Country:US
Practice Address - Phone:800-243-3839
Practice Address - Fax:855-527-5510
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11542208000000X
TN11542208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3179587Medicaid
TN4057650OtherBLUE CROSS BLUE SHIELD TN
370017664OtherRAILROAD MEDICARE PIN
370017664OtherRAILROAD MEDICARE PIN
TN3179587Medicaid