Active NPI
Gary G. Gordon, D.O.
- Geriatric Medicine (Family Medicine) Physician
- Meridian, MS
National Provider Identifier
1124010640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Family Medicine) Physician
- License
- 07448
- Practice address
- 1800 12TH St
Meridian, MS 39301-4158 - Phone
- (601) 703-9265
- Fax
- (601) 703-9401
- NPI assigned
- Aug 19, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 07448 | MS | Primary |
Addresses
Primary practice location
1800 12TH St
Meridian, MS 39301-4158
Mailing address
1800 12TH St
Meridian, MS 39301-4158
Phone (601) 703-9265
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04458061 | Medicaid | MS | |
| 73003105 | Other | AL | BLUE CROSS OF AL |
| 000039981 | Other | AL | MEDICAID OF AL |
| 0130017 | Other | MS | UNITED HEALTH CARE |
| 080030813 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07448 | MS | MD | Geriatric Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383696000000",
"number": "1124010640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 12TH ST",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393014158",
"telephone_number": "601-703-9265",
"fax_number": "601-703-9936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 12TH ST",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393014158",
"telephone_number": "601-703-9265",
"fax_number": "601-703-9401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "GARY",
"middle_name": "G.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-19",
"last_updated": "2013-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "MS",
"license": "07448",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04458061",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF AL",
"identifier": "73003105",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID OF AL",
"identifier": "000039981",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "0130017",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080030813",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.