Provider Demographics
NPI:1215934971
Name:GORDON, CRAIG DAVID (MD)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:DAVID
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9460 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:213-304-6199
Mailing Address - Fax:213-486-9249
Practice Address - Street 1:9460 WILSHIRE BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212
Practice Address - Country:US
Practice Address - Phone:213-304-6199
Practice Address - Fax:213-486-9249
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CAC54923207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABG9015872OtherDEA