Provider Demographics
NPI:1548321201
Name:STEPHEN M. GORDON. D.O., P.C
Entity type:Organization
Organization Name:STEPHEN M. GORDON. D.O., P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-942-3060
Mailing Address - Street 1:1004 CARONDELET DR
Mailing Address - Street 2:#407
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4802
Mailing Address - Country:US
Mailing Address - Phone:816-942-3060
Mailing Address - Fax:816-942-3141
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:#407
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4802
Practice Address - Country:US
Practice Address - Phone:816-942-3060
Practice Address - Fax:816-942-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14039022OtherBLUE CROSS BLUE SHIELD
MO10818069OtherBLUE CROSS BLUE SHIELD
MO33375001OtherBLUE CROSS BLUE SHIELD
MO33375001OtherBLUE CROSS BLUE SHIELD
MOC50876Medicare UPIN
MOK576583Medicare ID - Type UnspecifiedSTEPHEN M GORDON DO
MOC50872Medicare UPIN
MOK573935Medicare ID - Type Unspecified
MOK570026Medicare ID - Type Unspecified