Provider Demographics
NPI:1285616748
Name:GORDON, STEVEN G (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:9155 SW BARNES RD STE 204
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6629
Mailing Address - Country:US
Mailing Address - Phone:503-297-1390
Mailing Address - Fax:503-416-8145
Practice Address - Street 1:9155 SW BARNES RD STE 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6629
Practice Address - Country:US
Practice Address - Phone:503-297-1390
Practice Address - Fax:503-416-8145
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD19920OtherMD LICENSE #
OR081310Medicaid
ORG31449Medicare UPIN