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Individual

GORDON ENNS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
280 MAPLE ST, ASHLAND, OR 97520-1552
(541) 201-4000
(541) 488-7434
Mailing address
PO BOX 4749, MEDFORD, OR 97501-0227
(541) 789-5516
(541) 789-5538

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD10734
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
023507000
BLUE CROSS BLUE SHIELD
OR
05
235101
OR
01
930079056
RAILROAD MEDICARE
01
97520A009
CHAMPUS
01
C91177
GROUP HEALTH
01
XPY185046
MEDI - CAL
Enumeration date
04/03/2006
Last updated
07/14/2014
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