Provider Demographics
NPI:1972619997
Name:GLASGOW, GORDON ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:ARTHUR
Last Name:GLASGOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3433
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92690-1433
Mailing Address - Country:US
Mailing Address - Phone:714-402-9942
Mailing Address - Fax:949-364-7229
Practice Address - Street 1:26661 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1421
Practice Address - Country:US
Practice Address - Phone:714-402-9942
Practice Address - Fax:949-364-7229
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38908207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G389080Medicaid
CAG38908OtherMEDICAL LICENSE
AG8824965OtherDEA NARCOTICS LICENSE
AG8824965OtherDEA NARCOTICS LICENSE