Provider Demographics
NPI:1174657514
Name:GORDON, EURAL E (NP, PA-C)
Entity Type:Individual
Prefix:MR
First Name:EURAL
Middle Name:E
Last Name:GORDON
Suffix:
Gender:M
Credentials:NP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 STRAWBERRY MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-4488
Mailing Address - Country:US
Mailing Address - Phone:661-747-2795
Mailing Address - Fax:661-847-9776
Practice Address - Street 1:7400 DISTRICT BLVD STE C
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4818
Practice Address - Country:US
Practice Address - Phone:661-847-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14051363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3611140Medicaid