| Krista Gordon Md Pc | |
|
5366 Nw Cache Rd Suite 6 Lawton OK 73505-3353 | |
| (580) 536-7546 | |
| (580) 581-2051 |
| Full Name | Krista Gordon Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 5366 Nw Cache Rd, Lawton, Oklahoma |
| Authorized Official Name and Position | Rhonda Gelvin (OFFICE MANAGER) |
| Authorized Official Contact | 5805367546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Krista Gordon Md Pc 5366 Nw Cache Rd Suite 6 Lawton OK 73505-3335 Ph: (580) 536-7546 | Krista Gordon Md Pc 5366 Nw Cache Rd Suite 6 Lawton OK 73505-3353 Ph: (580) 536-7546 |
| NPI Number | 1275748501 |
|---|---|
| Provider Enumeration Date | 05/11/2007 |
| Last Update Date | 03/22/2011 |
| Medicare PECOS PAC ID | 0840388005 |
|---|---|
| Medicare Enrollment ID | O20071121000507 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275748501 | NPI | - | NPPES |
| 900522624 | Other | OK | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 21237 (Oklahoma) | Primary |
| Provider Name | Krista J Gordon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164426193 PECOS PAC ID: 4486742640 Enrollment ID: I20071121000501 |
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