Phyllis Gorin, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

30612 Issued in MN

Practice address

1020 Bandana Blvd W
Saint Paul, MN 55108-5107

Phone

(651) 241-9700

NPI assigned

Jul 4, 2006

Last updated

Nov 8, 2012By the provider in NPPES

Sex

Female

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 1

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352332800000",
    "number": "1740210723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 BANDANA BLVD W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085107",
            "telephone_number": "651-241-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORIN",
        "first_name": "PHYLLIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2012-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "30612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "913783100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley D Gordon, MD
• Nicole Marie Gordon, OTR
• Olivia Gordon
• Jolene Marie Gores
• Katherine Terese Ruzsa Gorham
• Jill Marie Goring, RN, CNS
• Jed Gorlin, MD
• Colleen Marie Gorman, PSY.D., LP
• Graci Marie Gorman, MD
• Hodd Heaney Gorman, DDS

• Pediatrics Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.

Verify at the official NPI Registry.