Provider Demographics
NPI:1932167541
Name:CLAWSON, GORDON MASARU (MD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:MASARU
Last Name:CLAWSON
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 1:171 FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3001
Mailing Address - Country:US
Mailing Address - Phone:805-646-6498
Mailing Address - Fax:805-646-6498
Practice Address - Street 1:1306 MARICOPA HWY
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3131
Practice Address - Country:US
Practice Address - Phone:805-640-2260
Practice Address - Fax:805-640-2360
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42967207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A429670Medicaid
E01666Medicare UPIN
CAWA42967CMedicare PIN