Healthcare Provider Details

I. General information

NPI: 1942272877
Provider Name (Legal Business Name): JANINE GORDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82211 MT ZION DR
DEXTER OR
97431-9779
US

IV. Provider business mailing address

82211 MT ZION DR
DEXTER OR
97431-9779
US

V. Phone/Fax

Practice location:
  • Phone: 541-937-8269
  • Fax:
Mailing address:
  • Phone: 541-937-8269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD16413
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: