Healthcare Provider Details

I. General information

NPI: 1447795125
Provider Name (Legal Business Name): DAN GORDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD, PV01 DEPT. OTOLARYNGOLOGY, OREGON HEALTH & SCIENCE UNIVERSIT
PORTLAND OR
97239-3098
US

IV. Provider business mailing address

7315 SW 33RD AVE
PORTLAND OR
97219-1854
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-4654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberFE177542
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: