Individual
DR. LAURA SIDNEY GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 SOUTHGATE, STE 6, PENDLETON, OR 97801-3974
(564) 276-6656
(541) 276-1496
Mailing address
1100 SOUTHGATE, STE 6, PENDLETON, OR 97801-3974
(564) 276-6656
(541) 276-1496
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD17630
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150155
—
OR
01
—
2408483-01
BC/BS OF OR PROVIDER #
OR
01
—
340020014
OR RAILROAD MEDICARE #
OR
01
—
W1033-01
PACIFICSOURCE PROVIDER #
OR
Enumeration date
09/22/2006
Last updated
07/09/2007
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