Individual
MICHAEL JEFFREY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1717 S J ST, TACOMA, WA 98405-4933
(253) 627-4930
(253) 627-4649
Mailing address
705 SHORELAND DR SE, BELLEVUE, WA 98004-6742
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD00016377
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1030766
—
WA
01
—
50106
L&I
—
01
—
GO6295
B/S REGENCE 90
—
Enumeration date
07/11/2006
Last updated
07/08/2007
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