Kevin Gordon
Contractor in Tulsa, OK. Individual provider (NPI-1).
NPI number1053723643
StatusActive
Last updated in NPPESMay 29, 2014
Details
- NPI
- 1053723643
- Entity type
- Individual (NPI-1)
- Name
- Kevin Gordon
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 29, 2014
- Last updated
- May 29, 2014
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171W00000X | Contractor | – | – | Yes |
Practice location
12222 E 30th StTulsa, OK 74129-8423
Phone 918-813-6340
Mailing address
12222 E 30th StTulsa, OK 74129-8423
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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