Gordon, Jacob L.
Gordon, Jacob L. is an individual health care provider with primary practice located at 9040 Jackson Avenue , Tacoma WA 98431. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Sleep Medicine. Allopathic & Osteopathic Physicians / Neurology is his primary health care specialty. Gordon, Jacob L. can be contacted via phone (253) 968-6478.Contact Information
Primary practice address
9040 Jackson Avenue
Tacoma WA 98431
Phone: (253) 968-6478
Fax: (253) 968-9054
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 4301077270 | Michigan |
| Allopathic & Osteopathic Physicians / Sleep Medicine | 2084S0012X | 4301077270 | Michigan |
| Allopathic & Osteopathic Physicians / Sleep Medicine | 2084S0012X | MD437980 | Pennsylvania |
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | MD437980 | Pennsylvania |
Profile Details
| NPI number | 1114029550 |
|---|---|
| LBN Legal business name | Gordon, Jacob L. |
| Credentials | M.D., M.S. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 5th, 2006 |
| Last updated | Mar 4th, 2019 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114029550 | NPPES |
| Pennsylvania | MEDICAID | 1023686220002 |
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