Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A118793 | CA |
N | 111NI0900X | Internist | A118793 | CA |
Y | 207RC0200X | Critical Care Medicine | A118793 | CA |
N | 207RP1001X | Pulmonary Disease | A118793 | CA |
NPI | 1063731966 |
---|---|
Provider Name | Dr. Nathaniel Gordon |
First Address | Sacramento, CA 95825-2296 |
Second Address | Sacramento, CA 95816-6510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2010 |
Last Update Date | 19/10/2020 |