MEDICARE: DR. MARGARET A 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	174400000X	Specialist	G21047	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1568462026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARET A GORDON M.D.

Provider Business Mailing Address
First Line	:	2524 HARRISON AVE
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-3229
Country	:	US
Telephone Number	:	707-443-8004
Fax Number	:	707-443-8007

Provider Business Practice Location Address
First Line	:	2524 HARRISON AVE
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-3229
Country	:	US
Telephone Number	:	707-443-8004
Fax Number	:	707-443-8007

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	09/27/2010

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