Active NPI
Herschel W Gordon, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Ukiah, CA
National Provider Identifier
1326033846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- C20719
- Practice address
- 275 Hospital Dr
Dept of Pathology
Ukiah, CA 95482-4531 - Phone
- (707) 462-3111
- Fax
- (707) 463-7509
- NPI assigned
- Sep 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | C20719 | CA | Primary |
Addresses
Primary practice location
275 Hospital Dr
Dept of Pathology
Ukiah, CA 95482-4531
Mailing address
275 Hospital Dr
Dept of Pathology
Ukiah, CA 95482-4531
Phone (707) 462-3111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C207190 | Medicaid | CA |
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 |
|---|---|---|---|
| C20719 | CA | MD | Anatomic Pathology & Clinical Pathology Physician |
| 20719 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412812800000",
"number": "1326033846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 HOSPITAL DR",
"address_2": "DEPT OF PATHOLOGY",
"city": "UKIAH",
"state": "CA",
"postal_code": "954824531",
"telephone_number": "707-462-3111",
"fax_number": "707-463-7509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 HOSPITAL DR",
"address_2": "DEPT OF PATHOLOGY",
"city": "UKIAH",
"state": "CA",
"postal_code": "954824531",
"telephone_number": "707-462-3111",
"fax_number": "707-463-7509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "HERSCHEL",
"middle_name": "W",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-12",
"last_updated": "2014-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "CA",
"license": "C20719",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00C207190",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ukiah, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.