Gordon, Glenn L
Gordon, Glenn L is an sole proprietor health care provider with primary practice located at 714 Medical Park Dr , Mexico MO 65265-3726. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Gordon, Glenn L can be contacted via phone (573) 590-1553.Contact Information
Primary practice address
714 Medical Park Dr
Mexico MO 65265-3726
Phone: (573) 590-1553
Fax: (877) 958-7717
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 036067470 | Illinois |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | R1H39 | Missouri |
Profile Details
| NPI number | 1427077213 |
|---|---|
| LBN Legal business name | Gordon, Glenn L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 19th, 2006 |
| Last updated | Oct 28th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1427077213 | NPPES |
| Missouri | Other | 0010137 | MEDICARE # |
| Missouri | Other | R1H39 | MEDICARE # |
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