Healthcare Provider Details

I. General information

NPI: 1003047408
Provider Name (Legal Business Name): DAVID MICHAEL GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE # M696 BOX 0110
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

1200 MASONIC AVE APT 2
SAN FRANCISCO CA
94117-2917
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1000
  • Fax:
Mailing address:
  • Phone: 415-265-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA108335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: