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NPI Code Detail

MEDICARE: DR. REBECCA GRACE GORDON MD

MEDICARE:  DR. REBECCA GRACE GORDON  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
12084P0800XPsychiatry PhysicianMD393419OR

General Provider Information

NPI Number : 1518076769
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REBECCA GRACE GORDON MD
Provider Business Mailing Address
First Line : 1614 POLK ST
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1725
Country : US
Telephone Number : 971-380-3088
Fax Number :
Provider Business Practice Location Address
First Line : 1614 POLK ST
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1725
Country : US
Telephone Number : 541-484-6700
Fax Number : 541-485-3343
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 10/27/2021

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Directions to “ DR. REBECCA GRACE GORDON MD” Practice Location

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