Provider Demographics
NPI:1467483156
Name:GORDON, JUDY C (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:C
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5682 BEE RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233
Mailing Address - Country:US
Mailing Address - Phone:941-371-3349
Mailing Address - Fax:941-371-9629
Practice Address - Street 1:5682 BEE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233
Practice Address - Country:US
Practice Address - Phone:941-371-3349
Practice Address - Fax:941-371-9629
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619414OtherBCBS GRP
IL1620469OtherBCBS GROUP NUMBER
IL3633309286030501Medicaid
IL036081029Medicaid
FL1467483156OtherNPI NUMBER
IL1620469OtherBCBS GROUP NUMBER
ILL98875Medicare ID - Type Unspecified
IL3633309286030501Medicaid
IL739531010 ICCMedicare PIN
IL216966013 EP & DP ICMedicare PIN