Provider Demographics
NPI:1043445349
Name:GORDON, DAVID MICHAEL (CNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:GORDON
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PARNASSUS AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3608
Mailing Address - Country:US
Mailing Address - Phone:415-353-4597
Mailing Address - Fax:415-353-9333
Practice Address - Street 1:350 PARNASSUS AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3608
Practice Address - Country:US
Practice Address - Phone:415-353-4597
Practice Address - Fax:415-353-9333
Is Sole Proprietor?:No
Enumeration Date:2009-05-16
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10630-NP363LA2200X
CA20565364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2960498Medicaid
OHP00729445OtherRAILROAD MEDICARE
OHGONP30921Medicare PIN