Provider Demographics
NPI:1447213004
Name:GORDON, JANET I (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:I
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7017 NE HIGHWAY 99
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0555
Mailing Address - Country:US
Mailing Address - Phone:360-694-0760
Mailing Address - Fax:360-694-1091
Practice Address - Street 1:7017 NE HWY 99
Practice Address - Street 2:SUITE 201
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665
Practice Address - Country:US
Practice Address - Phone:360-694-0760
Practice Address - Fax:360-694-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA0017326207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA83020001OtherSECURE HOR PACIFICARE
WA0615108OtherALL OTHER INS
WA1025675Medicaid
WA0927880001Medicare NSC
WA1025675Medicaid
WAG000615108Medicare PIN