Provider Demographics
NPI:1407464654
Name:RONALD GORDON MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RONALD GORDON MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MS
Authorized Official - Phone:216-443-0430
Mailing Address - Street 1:600 SUPERIOR AVE E STE 2400
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2691
Mailing Address - Country:US
Mailing Address - Phone:216-443-0430
Mailing Address - Fax:
Practice Address - Street 1:80729 VIA SAVONA
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7550
Practice Address - Country:US
Practice Address - Phone:216-870-6818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty