Provider Demographics
NPI:1548256464
Name:GORDON, SHERRY ALEXIS (MD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:ALEXIS
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 CITY POINT DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8380
Mailing Address - Country:US
Mailing Address - Phone:817-784-8268
Mailing Address - Fax:817-590-2285
Practice Address - Street 1:4300 CITY POINT DR
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8380
Practice Address - Country:US
Practice Address - Phone:817-784-8268
Practice Address - Fax:817-590-2285
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1715208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173501101Medicaid
TX173501102Medicaid
TX173501105Medicaid
TX173501103Medicaid
TX173501104OtherMEDICAID OTHER
TX8D6176Medicare PIN
TX173501103Medicaid
TX173501101Medicaid
TX8K3356Medicare PIN