Healthcare Provider Details

I. General information

NPI: 1366605875
Provider Name (Legal Business Name): NOAH ELLIOTT GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CALIFORNIA ST
SAN FRANCISCO CA
94118-1618
US

IV. Provider business mailing address

DEPT. 33995, PO BOX 39000
SAN FRANCISCO CA
94139
US

V. Phone/Fax

Practice location:
  • Phone: 415-719-0000
  • Fax:
Mailing address:
  • Phone: 503-372-2740
  • Fax: 503-372-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA90247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: