Lucius NMN Gordon Jr., PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10495233-1206 Issued in UT

Practice address

5640 S 3500 W
Roy, UT 84067-9158

Phone

(801) 773-2838

Fax

(801) 773-3025

NPI assigned

Nov 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1396814778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W ATTN: CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 S 3500 W",
            "city": "ROY",
            "state": "UT",
            "postal_code": "840679158",
            "telephone_number": "801-773-2838",
            "fax_number": "801-773-3025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4301 Mow-Way Road",
            "address_2": "Reynolds Army Community Hospital(ATTN Ms. Prescott)",
            "address_purpose": "LOCATION",
            "city": "Fort Sill",
            "state": "OK",
            "postal_code": "735036300",
            "country_code": "US",
            "telephone_number": "580-458-2134",
            "fax_number": "580-458-2314",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4301 Mow-Way Road",
            "address_2": "Reynolds Army Community Hospital(ATTN Ms. Prescott)",
            "address_purpose": "LOCATION",
            "city": "Fort Sill",
            "state": "OK",
            "postal_code": "735036300",
            "country_code": "US",
            "telephone_number": "580-458-2134",
            "fax_number": "580-458-2314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "LUCIUS",
        "middle_name": "NMN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10495233-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genesis Dental of Roy, LLC
• Laura C Giove, DO
• Jamie Gleason
• Glyna Glynn
• Nathan S Goff, PT-MDT
• Joseph Reganalberto Gouveia, CMHC
• Ed Greenhalgh, DPT
• Rodney K Grogan, PA-C
• Wyatt Haag
• Marianna Haaser

• Physician Assistant in Roy, UT
• Providers in Roy, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.