Basic Information
| Provider Information | |||||||||
| NPI: | 1881171163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | VICTORIA | ||||||||
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| Credential: | MPH, MD STUDENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1504 TAUB LOOP | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138737336 | ||||||||
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| Practice Location | |||||||||
| Address1: | 269 CRANWOOD DR | ||||||||
| Address2: | |||||||||
| City: | KEY BISCAYNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331491204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057724277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2018 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | T4635 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.