Randall Jay Gordon, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

036070173 Issued in IL

Practice address

2320 High St
Blue Island, IL 60406-2426

Phone

(708) 388-5500

Fax

(708) 388-5672

NPI assigned

Oct 14, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263254400000",
    "number": "1174512925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 HIGH ST",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062426",
            "telephone_number": "708-388-5500",
            "fax_number": "708-388-5672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 HIGH ST",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062426",
            "telephone_number": "708-388-5500",
            "fax_number": "708-388-5672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "RANDALL",
        "middle_name": "JAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2010-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036070173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036070173",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "160036380",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ehab Taher Awadi Ghandour, DMD
• Nicholas J Gierman, ATC
• Charlotte Amanda Glispie, PHARMD
• Anthony Kelly Goldboss, MD
• Laurie Sue Gordon, DDS
• Cynthia Grady
• Jasmine Gregorio
• Chantae Griffin, LCPC
• Guildhaus
• Guildhaus

• Obstetrics & Gynecology Physician in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.