Gordon, Earl Mark

Gordon, Earl Mark is an sole proprietor health care provider with primary practice located at 2021 Santa Monica Blvd Ste 421E , Santa Monica CA 90404-2144. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Gordon, Earl Mark can be contacted via phone (310) 453-4599.

Contact Information

Primary practice address
2021 Santa Monica Blvd Ste 421E Santa Monica CA 90404-2144
Phone: (310) 453-4599
Fax: (310) 453-6620
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X G 35140 California

Profile Details

NPI number 1053534925
LBN Legal business name Gordon, Earl Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 10th, 2007
Last updated Nov 21st, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053534925 NPPES
California MEDICAID ZZZ 73491 Z
California Other G 35140

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