Provider Demographics
NPI:1447243506
Name:GORDON, LINDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
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 1:798 S WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2928
Mailing Address - Country:US
Mailing Address - Phone:408-984-7226
Mailing Address - Fax:
Practice Address - Street 1:798 S WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2928
Practice Address - Country:US
Practice Address - Phone:408-984-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG721642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45534Medicare UPIN
00G721640Medicare PIN
CA00G721641Medicare PIN
CA00G721644Medicare PIN
00G721640Medicare PIN