Provider Demographics
NPI:1982666764
Name:GORDON, FLASH (MD)
Entity Type:Individual
Prefix:DR
First Name:FLASH
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 S ELISEO DR
Mailing Address - Street 2:STE 204
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2133
Mailing Address - Country:US
Mailing Address - Phone:415-461-2262
Mailing Address - Fax:415-461-9376
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:STE 204
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2133
Practice Address - Country:US
Practice Address - Phone:415-461-2262
Practice Address - Fax:415-461-9376
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG37304208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47033Medicare UPIN