Individual
JED A GORDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00037794
WA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD00037794
WA
207RP1001X
Pulmonary Disease Physician
Primary
MD00037794
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214344
LABOR & INDUSTRY
WA
01
—
5891740001
DME
WA
05
—
8274169
—
WA
01
—
8703GO
REGENCE
WA
01
—
P00442327
PALMETTO RR MEDICARE
WA
Enumeration date
09/20/2006
Last updated
05/25/2021
Update your record
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