Provider Demographics
NPI:1851489355
Name:GORDON, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8910 UNIVERSITY CENTER LN
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1031
Mailing Address - Country:US
Mailing Address - Phone:858-455-6800
Mailing Address - Fax:858-455-0244
Practice Address - Street 1:8910 UNIVERSITY CENTER LN
Practice Address - Street 2:SUITE 800
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1031
Practice Address - Country:US
Practice Address - Phone:858-455-6800
Practice Address - Fax:858-455-0244
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35946207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46528Medicare UPIN
CAG35946Medicare ID - Type Unspecified