| Doctor Name: | GORDON PATRICK MATTIMOE |
| NPI Number: | 1497007116 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP-C |
| License Number: | 709909 |
| Business Practice Address: | 208 Nw 2nd St Andrews, TX - 797146308 |
| Business Phone Number: | 4325241441 |
| Business Fax Number: | 4325241461 |
| Mailing Address: | 8228 San Antonio St, ODESSA |
| State: | TX |
| Postal Code: | 797658527 |
| Phone Number: | 4325241441 |
| Fax Number: | 4325241461 |
| NPI Enumeration Date: | 10/04/2012 |
| NPI Last Update Date: | 10/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 709909 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |