| Doctor Name: | MR. SCOTT ROBERT GORDON |
| NPI Number: | 1316233992 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MT (AMT) |
| License Number: | |
| Business Practice Address: | 330 Merlot Dr # 41 Prosser, WA - 993509551 |
| Business Phone Number: | 5094602947 |
| Business Fax Number: | |
| Mailing Address: | 330 Merlot Dr # 41, PROSSER |
| State: | WA |
| Postal Code: | 993509551 |
| Phone Number: | 5094602947 |
| Fax Number: | |
| NPI Enumeration Date: | 06/22/2011 |
| NPI Last Update Date: | 06/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246QM0706X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Spec/Tech, Pathology |
| Taxonomy Specialization: | Medical Technologist |
| Taxonomy Definition: | |