Provider Demographics
NPI:1801980479
Name:GORDON, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11126 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2806
Mailing Address - Country:US
Mailing Address - Phone:865-777-0088
Mailing Address - Fax:865-777-2015
Practice Address - Street 1:11126 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2806
Practice Address - Country:US
Practice Address - Phone:865-777-0088
Practice Address - Fax:865-777-2015
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN59786207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF82268Medicare UPIN