Healthcare Provider Details

I. General information

NPI: 1831053792
Provider Name (Legal Business Name): RAYMONDO B. GORDON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 2ND ST SW
ROCHESTER MN
55902-1906
US

IV. Provider business mailing address

537 NORTHERN HILLS DR NE APT 32
ROCHESTER MN
55906-4035
US

V. Phone/Fax

Practice location:
  • Phone: 507-255-6926
  • Fax:
Mailing address:
  • Phone: 507-255-6926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR191305-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: