MEDICARE: MR. CRAIG DAVID GORDON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	C54923	CA

General Provider Information

NPI Number	:	1215934971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG DAVID GORDON MD

Provider Business Mailing Address
First Line	:	9460 WILSHIRE BLVD
Second Line	:	SUITE 420
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212
Country	:	US
Telephone Number	:	213-304-6199
Fax Number	:	213-486-9249

Provider Business Practice Location Address
First Line	:	9460 WILSHIRE BLVD
Second Line	:	SUITE 420
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212
Country	:	US
Telephone Number	:	213-304-6199
Fax Number	:	213-486-9249

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/07/2023

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