Provider Demographics
NPI:1538157771
Name:VINCENT, GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:
Last Name:VINCENT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1901 SOUTH 1ST STREET
Mailing Address - Street 2:IMAGING SERVICE (114T)
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7451
Mailing Address - Country:US
Mailing Address - Phone:254-743-0875
Mailing Address - Fax:254-742-4682
Practice Address - Street 1:1901 SOUTH 1ST STREET
Practice Address - Street 2:IMAGING SERVICE (114T)
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-743-0875
Practice Address - Fax:254-742-4682
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF20832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology