Provider Demographics
NPI:1689610362
Name:ZINK-BRODY, GORDON CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:CHRISTOPHER
Last Name:ZINK-BRODY
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 1:4445 EASTGATE MALL
Mailing Address - Street 2:STE 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1979
Mailing Address - Country:US
Mailing Address - Phone:858-357-9450
Mailing Address - Fax:858-412-6376
Practice Address - Street 1:150 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2005
Practice Address - Country:US
Practice Address - Phone:619-295-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG686362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689610362Medicaid
CA00G686360OtherBS
CA00G686360Medicaid
CA00G686365Medicare PIN
CA300107760Medicare PIN
CAFE255VMedicare PIN
CA00G6863611Medicare PIN
CA00G686360Medicare PIN
CA00G686360OtherBS
CA00G6863612Medicare PIN
CA00G6863614Medicare PIN
CA00G686369Medicare PIN
CA00G686363Medicare PIN
CA00G686360Medicaid
CA00G6863615Medicare PIN
CA00G686362Medicare PIN
CAFE255XMedicare PIN
CA00G6863610Medicare PIN
CA00G686361Medicare PIN
CA00G686366Medicare PIN
CA00G686367Medicare PIN
CAFE255UMedicare PIN
CA00G6863613Medicare PIN
CA00G686368Medicare PIN