Provider Demographics
NPI:1275502015
Name:VALLEY VASCULAR SURGEONS PC
Entity Type:Organization
Organization Name:VALLEY VASCULAR SURGEONS PC
Other - Org Name:DR RONALD D GORDON
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-482-7676
Mailing Address - Street 1:3811 EAST BELL RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:602-482-7676
Mailing Address - Fax:602-482-6152
Practice Address - Street 1:3811 EAST BELL RD
Practice Address - Street 2:SUITE 208
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:602-482-7676
Practice Address - Fax:602-482-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty