Provider Demographics
NPI:1700881257
Name:GORDON, SLOAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SLOAN
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TEMPRANILLO
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5682
Mailing Address - Country:US
Mailing Address - Phone:713-725-7555
Mailing Address - Fax:713-583-1791
Practice Address - Street 1:14 TEMPRANILLO
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5682
Practice Address - Country:US
Practice Address - Phone:713-725-7555
Practice Address - Fax:713-583-1791
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5616213EP1101X
TX803213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1992787204OtherGROUP NPI
TX089494103Medicaid
TXT13517Medicare UPIN
TX089494103Medicaid
TX8409M0Medicare PIN