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General NPI Number Information
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NPI Number | 1063460517
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Entity Type | Individual
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Provider Name | RONALD S GORDON MD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 901 CAMPUS DR STE 206B
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City | DALY CITY
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State | CA
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Zip | 94015-4932
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Country | US
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Telephone | 650-356-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 53765 VIA DONA
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City | LA QUINTA
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State | CA
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Zip | 92253-7841
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Country | US
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Telephone | 216-956-8994
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35069626
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License Number State | OH
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