Organization
CARL J. GORDON, M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL JEFFREY GORDON M.D. (PRESIDENT)
(323) 931-2606
Entity
Organization
Contact information
Practice address
6360 WILSHIRE BLVD, SUITE 409, LOS ANGELES, CA 90048-5603
(323) 931-2606
(323) 931-2927
Mailing address
6360 WILSHIRE BLVD, SUITE 409, LOS ANGELES, CA 90048-5603
(323) 931-2606
(323) 931-2927
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
G9592
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000G95920
—
CA
01
—
G9592
CALIFORNIA MEDICAL LICENSE
CA
Enumeration date
07/11/2008
Last updated
07/14/2009
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