Provider Demographics
NPI:1245263938
Name:BERNARD I. GORDON, M.D., INC.
Entity type:Organization
Organization Name:BERNARD I. GORDON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-346-5377
Mailing Address - Street 1:2299 POST ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3441
Mailing Address - Country:US
Mailing Address - Phone:415-346-5377
Mailing Address - Fax:415-346-6055
Practice Address - Street 1:2299 POST ST
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3441
Practice Address - Country:US
Practice Address - Phone:415-346-5377
Practice Address - Fax:415-346-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty