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1356320196

NPI Code Detail

MEDICARE: JOHN DAVID GORDON M.D.

MEDICARE: JOHN DAVID 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
1	207Q00000X	Family Medicine Physician	23951	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	C103008	OTHER	CO	MEDICARE GROUP NUMBER
6	080115217	OTHER	CO	RAILROAD MEDICARE
11	513142	OTHER	CO	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4052059	OTHER	CO	AETNA
3	RO103008	OTHER	CO	GROUP ANTHEM BCBS
4	261603	OTHER	CO	CIGNA
5	841365302002	OTHER	CO	RKY MTN HMO
7	84136530224	OTHER	CO	PACIFICARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	1215981634	OTHER	CO	GROUP NPI #
10	1356320196	OTHER	CO	NPI #
12	8413653020A	OTHER	CO	PACIFICARE PPO
13	GO189518	OTHER	CO	ANTHEM BCBS
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356320196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DAVID GORDON M.D.

Provider Business Mailing Address
First Line	:	7625 W 92ND AVE
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-4567
Country	:	US
Telephone Number	:	303-254-7468
Fax Number	:	303-650-2287

Provider Business Practice Location Address
First Line	:	7625 W 92ND AVE
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-4567
Country	:	US
Telephone Number	:	303-254-7468
Fax Number	:	303-650-2287

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	08/24/2016

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Directions to “ JOHN DAVID GORDON M.D.” Practice Location

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