Healthcare Provider Details

I. General information

NPI: 1205871241
Provider Name (Legal Business Name): JAMES GORDON MD, FRCPC, PLLC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 N 115TH ST SUITE 330
SEATTLE WA
98133-8400
US

IV. Provider business mailing address

1536 N 115TH ST SUITE 330
SEATTLE WA
98133-8400
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-0111
  • Fax: 206-365-2980
Mailing address:
  • Phone: 206-365-0111
  • Fax: 206-365-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number33598
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License Number33598
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: