MEDICARE: CARL J GORDON M D INC

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	207W00000X	Ophthalmology Physician	G9592	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G9592	OTHER	CA	PROVIDER NUMBER
3	952910439	OTHER	CA	EMPLOYER I.D.
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528175007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL J GORDON M D INC

Provider Business Mailing Address
First Line	:	6360 WILSHIRE BLVD
Second Line	:	SUITE 409
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5603
Country	:	US
Telephone Number	:	323-931-2606
Fax Number	:	323-931-2927

Provider Business Practice Location Address
First Line	:	6360 WILSHIRE BLVD
Second Line	:	SUITE 409
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5603
Country	:	US
Telephone Number	:	323-931-2606
Fax Number	:	323-931-2927

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/14/2009

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Directions to “ CARL J GORDON M D INC” Practice Location

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