Provider Demographics
NPI:1033282181
Name:GORDIN, RAYLENE LORRAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYLENE
Middle Name:LORRAINE
Last Name:GORDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37686 KATHLEEN CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-8832
Mailing Address - Country:US
Mailing Address - Phone:503-580-0761
Mailing Address - Fax:503-213-5948
Practice Address - Street 1:1296 COMMERCIAL ST. SE
Practice Address - Street 2:SUITE 103
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4200
Practice Address - Country:US
Practice Address - Phone:503-580-0761
Practice Address - Fax:503-213-5948
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19742207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR081356Medicaid
ORG30645Medicare UPIN
110344Medicare ID - Type Unspecified