Active NPI
John Edward Gordon, M.D.
- Psychiatry Physician
- Coeur D' Alene, ID
National Provider Identifier
1093868051
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- IDAHOM-6213
- Practice address
- 1200 W. Ironwood
Suite # 306
Coeur D' Alene, ID 83814 - Phone
- (208) 651-1335
- Fax
- (208) 765-0779
- NPI assigned
- Jan 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | M-6213 | ID | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | M-6213 | ID | |
| Psychiatry Physician | 2084P0800X | IDAHOM-6213 | ID | Primary |
Addresses
Primary practice location
1200 W. Ironwood
Suite # 306
Coeur D' Alene, ID 83814
Mailing address
1200 W. Ironwood
Suite # 306
Coeur D' Alene, ID 83814
Phone (208) 651-1335
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001185400 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IDAHOM-6213 | ID | MD | Psychiatry Physician |
| M-6213 | ID | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254268800000",
"number": "1093868051",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 W. IRONWOOD",
"address_2": "SUITE # 306",
"city": "COEUR D' ALENE",
"state": "ID",
"postal_code": "83814",
"telephone_number": "208-651-1335",
"fax_number": "208-765-0779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 W. IRONWOOD",
"address_2": "SUITE # 306",
"city": "COEUR D' ALENE",
"state": "ID",
"postal_code": "83814",
"telephone_number": "208-651-1335",
"fax_number": "208-765-0779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "JOHN",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-20",
"last_updated": "2009-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ID",
"license": "M-6213",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "ID",
"license": "M-6213",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ID",
"license": "IDAHOM-6213",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001185400",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coeur D' Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.