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1326000670

NPI Code Detail

MEDICARE: GORDON ENNS MD

MEDICARE: GORDON ENNS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	MD10734	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	930079056	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C91177	OTHER		GROUP HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C91177	OTHER		PROVIDENCE HEALTH PLANS
4	023507000	OTHER	OR	BLUE CROSS BLUE SHIELD
6	XPY185046	OTHER		MEDI - CAL
7	97520A009	OTHER		CHAMPUS

General Provider Information

NPI Number	:	1326000670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON ENNS MD

Provider Business Mailing Address
First Line	:	PO BOX 4749
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-0227
Country	:	US
Telephone Number	:	541-789-5516
Fax Number	:	541-789-5538

Provider Business Practice Location Address
First Line	:	280 MAPLE ST
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-1552
Country	:	US
Telephone Number	:	541-201-4000
Fax Number	:	541-488-7434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	07/14/2014

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Directions to “ GORDON ENNS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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