Healthcare Provider Details

I. General information

NPI: 1043445349
Provider Name (Legal Business Name): DAVID MICHAEL GORDON CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2009
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARNASSUS AVE SUITE 404
SAN FRANCISCO CA
94117-3608
US

IV. Provider business mailing address

350 PARNASSUS AVE SUITE 404
SAN FRANCISCO CA
94117-3608
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-4597
  • Fax: 415-353-9333
Mailing address:
  • Phone: 415-353-4597
  • Fax: 415-353-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.10630-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number20565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: