Gordon, Randall Jay

Gordon, Randall Jay is an individual health care provider with primary practice located at 2320 High St , Blue Island IL 60406-2426. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Gordon, Randall Jay can be contacted via phone (708) 388-5500.

Contact Information

Primary practice address
2320 High St Blue Island IL 60406-2426
Phone: (708) 388-5500
Fax: (708) 388-5672
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 036070173 Illinois

Profile Details

NPI number 1174512925
LBN Legal business name Gordon, Randall Jay
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 14th, 2005
Last updated Jan 12th, 2010 - about 16 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 1174512925 NPPES
Illinois MEDICAID 036070173
Illinois Other 160036380

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