Provider Demographics
NPI:1063460517
Name:GORDON, RONALD S (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:GORDON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53765 VIA DONA
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7841
Mailing Address - Country:US
Mailing Address - Phone:216-956-8994
Mailing Address - Fax:
Practice Address - Street 1:901 CAMPUS DR STE 206B
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4932
Practice Address - Country:US
Practice Address - Phone:650-356-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069626207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine