Provider Demographics
NPI:1740320811
Name:GORDON, PATRICIA S (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
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 1:8900 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1958
Mailing Address - Country:US
Mailing Address - Phone:310-432-8900
Mailing Address - Fax:310-432-8901
Practice Address - Street 1:8900 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1958
Practice Address - Country:US
Practice Address - Phone:310-432-8900
Practice Address - Fax:310-432-8901
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG533532085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G533531Medicaid
CAG53353OtherCA LICENSE
CAA002OtherTRIWEST PROVIDER #
W21577Medicare PIN
E23405Medicare UPIN
CAWG53353IMedicare PIN