Provider Demographics
NPI:1801033055
Name:SANFORD, GORDON RAYMOND (PA-C)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:RAYMOND
Last Name:SANFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 N PALM CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4412
Mailing Address - Country:US
Mailing Address - Phone:760-322-2520
Mailing Address - Fax:760-322-4021
Practice Address - Street 1:1492 N PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4412
Practice Address - Country:US
Practice Address - Phone:760-322-2520
Practice Address - Fax:760-322-4021
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12992363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical