Provider Demographics
NPI:1932106671
Name:LEMM, GORDON D (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:D
Last Name:LEMM
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 1:292 POSADA LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4054
Mailing Address - Country:US
Mailing Address - Phone:805-434-3211
Mailing Address - Fax:805-434-2019
Practice Address - Street 1:292 POSADA LN
Practice Address - Street 2:SUITE D
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4054
Practice Address - Country:US
Practice Address - Phone:805-434-3211
Practice Address - Fax:805-434-2019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-05-02
Provider Licenses
StateLicense IDTaxonomies
CAG44422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G444220Medicaid
CA00G444220Medicaid
CAG44422Medicare ID - Type Unspecified