Healthcare Provider Details

I. General information

NPI: 1265088926
Provider Name (Legal Business Name): SARAH KATE GORDON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N OGDEN ST STE 310
DENVER CO
80218-1277
US

IV. Provider business mailing address

1690 S MARION ST
DENVER CO
80210-2753
US

V. Phone/Fax

Practice location:
  • Phone: 720-401-2139
  • Fax:
Mailing address:
  • Phone: 949-689-6577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7554
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: