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Individual
JESSE GORDON
Active
Individual
JESSE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
20A12984
CA
207Q00000X
Family Medicine Physician
Primary
R3519
TX
390200000X
Student in an Organized Health Care Education/Training Program
125056829
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102936677
—
PA
Enumeration date
07/01/2009
Last updated
01/14/2021
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