Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | G57978 | CA |
NPI | 1184669905 |
---|---|
Provider Name | Michael Louis Gordon |
First Address | Newport Beach, CA 92660-7901 |
Second Address | Newport Beach, CA 92660-7901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 17/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A53357 | (02) | CA |
GU326Z | (02) | CA |