Provider Demographics
NPI:1184812489
Name:MARTIN N GORDON MD
Entity type:Organization
Organization Name:MARTIN N GORDON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-432-4260
Mailing Address - Street 1:9401 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 515
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2928
Mailing Address - Country:US
Mailing Address - Phone:310-432-6260
Mailing Address - Fax:
Practice Address - Street 1:9401 WILSHIRE BLVD
Practice Address - Street 2:SUITE 515
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2928
Practice Address - Country:US
Practice Address - Phone:310-432-6260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31316207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19450Medicare PIN