Jeoffry Bruce Gordon, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G19279 Issued in CA

Practice address

1947 Cable St
San Diego, CA 92107-2807

Phone

(619) 223-7164

Fax

(619) 223-5443

NPI assigned

Aug 24, 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

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Family Health Centers of San Diego, Inc

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1447281936
  Medicare reassignment NPD
• Family Health Centers of San Diego Inc

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
  • NPI 1083959464
  NPD
• Family Health Centers of San Diego Inc

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1528331287
  NPD
• Family Health Centers of San Diego Inc

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1952729303
  NPD
• Ocean Beach Medical Group

  • Non-Pharmacy Dispensing Site
  • San Diego, CA
  • NPI 1699032938
  NPD (past)

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1649263682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-525-2300",
            "fax_number": "619-906-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1947 CABLE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921072807",
            "telephone_number": "619-223-7164",
            "fax_number": "619-223-5443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JEOFFRY",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-24",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G19279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G192790",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCE #",
            "identifier": "G19279",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emile Brink Gordon, MD
• Erin Duncan Gordon, M.D.
• Grant D Gordon
• Gretchen Alice Gordon, RN
• Jake Hodges Gordon, MD
• Jerome Louis Gordon III
• John B Gordon, M.D.
• John Ray Gordon, D.D.S.
• Joseph Gordon, D.D.S.
• Josh L. Gordon, M.D.

• Family Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.