# JESSE GORDON

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1891923595
- **Gender:** F
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 20A12984 | CA | — |
| 207Q00000X | Family Medicine Physician | R3519 | TX | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | 125056829 | IL | — |

## Other

- **Enumeration date:** 07/01/2009
- **Last updated:** 01/14/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 102936677 | — | PA |