Provider Demographics
NPI:1427085745
Name:LEVIN, GORDON LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:LEONARD
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14901 NATIONAL AVE
Mailing Address - Street 2:# 101
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2637
Mailing Address - Country:US
Mailing Address - Phone:408-356-4774
Mailing Address - Fax:408-356-8072
Practice Address - Street 1:14901 NATIONAL AVE
Practice Address - Street 2:# 101
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2637
Practice Address - Country:US
Practice Address - Phone:408-356-4774
Practice Address - Fax:408-356-8072
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17837207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG178370Medicaid
CAG178370Medicaid
CAG178370Medicaid
CA0281240001Medicare NSC
A40205Medicare UPIN