Provider Demographics
NPI:1902829955
Name:GORDON, STEWART THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:THOMAS
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 ARCHIVES AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2423
Mailing Address - Country:US
Mailing Address - Phone:225-201-8475
Mailing Address - Fax:844-809-3193
Practice Address - Street 1:8585 ARCHIVES AVE STE 310
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2423
Practice Address - Country:US
Practice Address - Phone:225-201-8475
Practice Address - Fax:844-809-3193
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020853208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1969214Medicaid
LA1969214Medicaid
5R747DD21Medicare PIN
5R747Medicare ID - Type Unspecified