O T Gordon Jr., M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

C5353 Issued in AR

Practice address

1609 W 40TH Ave
Suite 312
Pine Bluff, AR 71603-6329

Phone

(870) 534-3344

Fax

(870) 534-3517

NPI assigned

Apr 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pine Bluff Endoscopy Center, LLC

  • Endoscopy Clinic/Center
  • Pine Bluff, AR
  • NPI 1275541427
  NPD (past)

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269820800000",
    "number": "1457314288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 312",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036329",
            "telephone_number": "870-534-3344",
            "fax_number": "870-534-3517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "SUITE 312",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036329",
            "telephone_number": "870-534-3344",
            "fax_number": "870-534-3517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "O",
        "middle_name": "T",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2010-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AR",
            "license": "C5353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152438001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4198220",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2900041",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00092540",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5M782",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "03120019200",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Commeka Goodloe
• Rhamonia Lynetta Goodlow, LPN
• Tacarra Michelle Goodwin, LCSW
• Destiny Gordon
• Nikki Pepino Gordon, RPT
• Jeffrey Tad Goss, PHARMD
• Shacoya Latrece Grady, LPN
• Rontae Marvell Edward Graham, DDS
• Rebecca Grandy, APN
• Gray-Millenbaugh Practitioner Healthcare, LLC

• Gastroenterology Physician in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Gastroenterology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; 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.