Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | A041223 | CA |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | A41223 | CA |
NPI | 1306987946 |
---|---|
Provider Name | Mark Lorry Gordon |
First Address | Encino, CA 91436-1914 |
Second Address | Encino, CA 91436-1914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |