Gordon, Glenn

Gordon, Glenn is an individual health care provider with primary practice located at 2073 Olympic St , Springfield OR 97477. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is his primary health care specialty. Gordon, Glenn can be contacted via phone (541) 682-3550.

Contact Information

Primary practice address
2073 Olympic St Springfield OR 97477
Phone: (541) 682-3550
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X MD15934 Oregon
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD15934 Oregon
Allopathic & Osteopathic Physicians / General Practice 208D00000X MD15934 Oregon

Profile Details

NPI number 1538108261
LBN Legal business name Gordon, Glenn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated May 15th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538108261 NPPES
Oregon MEDICAID 057141
Oregon Other J0475-05
Oregon Other C89984
Oregon Other 76172
Oregon Other 057221003
Oregon MEDICAID 8280034
Oregon Other A018
Oregon Other C89984
Oregon Other C89984
Oregon MEDICAID XPY185053

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