Provider Demographics
NPI:1447353313
Name:GORDON, MARTIN N (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:N
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 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:310-432-4260
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:310-432-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31316207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G313160Medicaid
CAWG31316CMedicare PIN
CAA91336Medicare UPIN