Provider Demographics
NPI:1356320196
Name:GORDON, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4567
Mailing Address - Country:US
Mailing Address - Phone:303-254-7468
Mailing Address - Fax:303-650-2287
Practice Address - Street 1:7625 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4567
Practice Address - Country:US
Practice Address - Phone:303-254-7468
Practice Address - Fax:303-650-2287
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4052059OtherAETNA
COC103008OtherMEDICARE GROUP NUMBER
CORO103008OtherGROUP ANTHEM BCBS
CO261603OtherCIGNA
CO841365302002OtherRKY MTN HMO
CO080115217OtherRAILROAD MEDICARE
CO84136530224OtherPACIFICARE
CO04020541Medicaid
CO1215981634OtherGROUP NPI #
CO1356320196OtherNPI #
CO513142OtherMEDICARE GROUP
CO8413653020AOtherPACIFICARE PPO
COGO189518OtherANTHEM BCBS
CO01239516Medicaid
CO300217Medicare PIN
CO1215981634OtherGROUP NPI #
E73732Medicare UPIN