Active NPI
Gilad Shalag Gordon, MD
- Internal Medicine Physician
- Boulder, CO
National Provider Identifier
1609110006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 26496
- Practice address
- 1565 Rockmont Cir
Boulder, CO 80305-6822 - Phone
- (303) 517-6212
- Fax
- (303) 494-4103
- NPI assigned
- Nov 26, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 26496 | CO | Primary |
Addresses
Primary practice location
1565 Rockmont Cir
Boulder, CO 80305-6822
Mailing address
1565 Rockmont Cir
Boulder, CO 80305-6822
Phone (303) 517-6212
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26496 | CO | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cathy J Cohn, PHD, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Boulder, CO
- NPI 1417186909
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353888000000",
"number": "1609110006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1565 ROCKMONT CIR",
"city": "BOULDER",
"state": "CO",
"postal_code": "803056822",
"telephone_number": "303-517-6212",
"fax_number": "303-494-4103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1565 ROCKMONT CIR",
"city": "BOULDER",
"state": "CO",
"postal_code": "803056822",
"telephone_number": "303-517-6212",
"fax_number": "303-494-4103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "GILAD",
"middle_name": "SHALAG",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-26",
"last_updated": "2012-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CO",
"license": "26496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.