Provider Demographics
NPI:1518076769
Name:GORDON, REBECCA GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:GRACE
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 1:1614 POLK ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1725
Mailing Address - Country:US
Mailing Address - Phone:971-380-3088
Mailing Address - Fax:
Practice Address - Street 1:1614 POLK ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1725
Practice Address - Country:US
Practice Address - Phone:541-484-6700
Practice Address - Fax:541-485-3343
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD3934192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry