MEDICARE: DR. GORDON SAM RASKIN M.D.

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	207Q00000X	Family Medicine Physician	A45357	CA

General Provider Information

NPI Number	:	1962498220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GORDON SAM RASKIN M.D.

Provider Business Mailing Address
First Line	:	5842 ROBINHOOD DR
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-3548
Country	:	US
Telephone Number	:	510-757-9545
Fax Number	:	510-758-7533

Provider Business Practice Location Address
First Line	:	5842 ROBINHOOD DR
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-3548
Country	:	US
Telephone Number	:	510-757-9545
Fax Number	:	510-758-7533

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	01/23/2012

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