Provider Demographics
NPI:1609110006
Name:GORDON, GILAD SHALAG (MD)
Entity Type:Individual
Prefix:DR
First Name:GILAD
Middle Name:SHALAG
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 ROCKMONT CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6822
Mailing Address - Country:US
Mailing Address - Phone:303-517-6212
Mailing Address - Fax:303-494-4103
Practice Address - Street 1:1565 ROCKMONT CIR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6822
Practice Address - Country:US
Practice Address - Phone:303-517-6212
Practice Address - Fax:303-494-4103
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine