Provider Demographics
NPI:1083636138
Name:GORDY, DORIS W (PA)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:W
Last Name:GORDY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5921
Mailing Address - Country:US
Mailing Address - Phone:559-584-6499
Mailing Address - Fax:559-584-8124
Practice Address - Street 1:7471 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2457
Practice Address - Country:US
Practice Address - Phone:559-436-4500
Practice Address - Fax:559-261-1526
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-09-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18354Medicaid