Provider Demographics
NPI:1659453108
Name:GORDON, RONALD JEFFERY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JEFFERY
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 1:199 LUQUER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4518
Mailing Address - Country:US
Mailing Address - Phone:206-919-7865
Mailing Address - Fax:
Practice Address - Street 1:199 LUQUER ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4518
Practice Address - Country:US
Practice Address - Phone:206-919-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86320207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABZ195ZMedicare PIN
TNB04798Medicare UPIN