Gordon, Otis T

Gordon, Otis T is an individual health care provider with primary practice located at 417 N University Ave , Little Rock AR 72205-3108. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Gordon, Otis T can be contacted via phone (501) 666-0249.

Contact Information

Primary practice address
417 N University Ave Little Rock AR 72205-3108
Phone: (501) 666-0249
Fax: (501) 666-4340
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X E4082 Arkansas

Profile Details

NPI number 1851355218
LBN Legal business name Gordon, Otis T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2006
Last updated Dec 17th, 2012 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851355218 NPPES
Arkansas Other P00348668 RAIL ROAD MEDICARE
Arkansas Other 03120019200 RAIL ROAD MEDICARE
Arkansas MEDICAID 156781001 RAIL ROAD MEDICARE
Arkansas Other 5N145 RAIL ROAD MEDICARE
Arkansas Other 7867673 RAIL ROAD MEDICARE

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