Provider Demographics
NPI:1336290881
Name:GORDON, DEBORAH LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LEE
Last Name:GORDON
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 1:1607 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2400
Mailing Address - Country:US
Mailing Address - Phone:541-482-8333
Mailing Address - Fax:541-482-8398
Practice Address - Street 1:1607 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2400
Practice Address - Country:US
Practice Address - Phone:541-482-8333
Practice Address - Fax:541-482-8398
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182907Medicaid
OR182907Medicaid
OR0000BKBLJMedicare ID - Type Unspecified