Individual
DR. BENJAMIN HOLLIS JAMES GORDON
Active
Individual
DR. BENJAMIN HOLLIS JAMES GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5763853-1205
UT
2085R0202X
Diagnostic Radiology Physician
A103290
CA
2085R0202X
Diagnostic Radiology Physician
M-10369
ID
2085R0202X
Diagnostic Radiology Physician
MD 60033967
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010171612
REGENCE BLUE SHIELD OF IDAHO
ID
01
—
77798
BLUE CROSS OF IDAHO
ID
05
—
808281600
—
ID
05
—
8536039
—
WA
Enumeration date
09/20/2007
Last updated
06/01/2023
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