Individual
RANDALL JAY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2320 HIGH ST, BLUE ISLAND, IL 60406-2426
(708) 388-5500
(708) 388-5672
Mailing address
2320 HIGH ST, BLUE ISLAND, IL 60406-2426
(708) 388-5500
(708) 388-5672
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036070173
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036070173
—
IL
01
—
160036380
RAILROAD MEDICARE
IL
Enumeration date
10/14/2005
Last updated
01/12/2010
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