Gordley Plastic Surgery PA

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

M7222 Issued in TX

Legal business name

GORDLEY PLASTIC SURGERY PA

Practice address

129 Vision Park Blvd Ste 210
Shenandoah, TX 77384-3024

Phone

(832) 813-5839

Fax

(832) 813-8512

NPI assigned

Mar 19, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kyle Patrick Gordley, M.D.NPI 1437328002

Title

M.D./Owner

Phone

(832) 813-5839

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• KYLE P GORDLEY MD Other name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle Patrick Gordley, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Shenandoah, TX
  • NPI 1437328002
  Medicare reassignment NPD Authorized official
• Bryan J Correa, M.D.

  • Plastic Surgery Physician
  • The Woodlands, TX
  • NPI 1306085535

  Plastic and Reconstructive Surgery

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597104000000",
    "number": "1083885891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 VISION PARK BLVD STE 210",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773843024",
            "telephone_number": "832-813-5839",
            "fax_number": "832-813-8512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 VISION PARK BLVD STE 210",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773843024",
            "telephone_number": "832-813-5839",
            "fax_number": "832-813-8512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GORDLEY PLASTIC SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A",
        "authorized_official_last_name": "GORDLEY",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "M.D./OWNER",
        "authorized_official_telephone_number": "832-813-5839",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TX",
            "license": "M7222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MC PIN",
            "identifier": "DP0233",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "336661901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KYLE P GORDLEY MD",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "KYLE P GORDLEY MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Andrew Shagor Gomes, DDS
• Sarah Laurelle Gomez
• Anna M Gonzales, M.D.
• Edgardo Mauricio Gonzalez, CSA, LSA
• Manuel Gonzalez
• Kyle Patrick Gordley, M.D.
• Natalie Danielle Gordon, M.D.
• Steven Lars Gordon, M.D.
• Andrea R Gourdine, PHD, MS, LPC, NCC
• Dante Gravino, PHARMD

• Plastic and Reconstructive Surgery Physician in Shenandoah, TX
• Providers in Shenandoah, TX by specialty
• Plastic and Reconstructive Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.