Provider Demographics
NPI:1942272877
Name:GORDON, JANINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82211 MT ZION DR
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:OR
Mailing Address - Zip Code:97431-9779
Mailing Address - Country:US
Mailing Address - Phone:541-937-8269
Mailing Address - Fax:
Practice Address - Street 1:82211 MT ZION DR
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:OR
Practice Address - Zip Code:97431-9779
Practice Address - Country:US
Practice Address - Phone:541-937-8269
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD164132084P0800X
CA267472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE33788Medicare UPIN