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NPI Code Detail

MEDICARE: HERSCHEL W GORDON M.D.

MEDICARE: HERSCHEL W GORDON M.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianC20719CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326033846
Entity Type Code : Individual
Provider Name (Legal Business Name) : HERSCHEL W GORDON M.D.
Provider Business Mailing Address
First Line : 275 HOSPITAL DR
Second Line : DEPT OF PATHOLOGY
City : UKIAH
State : CA
Zip : 95482-4531
Country : US
Telephone Number : 707-462-3111
Fax Number : 707-463-7509
Provider Business Practice Location Address
First Line : 275 HOSPITAL DR
Second Line : DEPT OF PATHOLOGY
City : UKIAH
State : CA
Zip : 95482-4531
Country : US
Telephone Number : 707-462-3111
Fax Number : 707-463-7509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 10/09/2014

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