National Provider Identifier Database

GLENN GORDON, MD – NPI #1538108261
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Contact Information

GLENN GORDON, MD
2073 OLYMPIC ST
SPRINGFIELD, OR  97477
Phone: 541-682-3550
Fax:
Website:
Specialty Taxonomy Code
* General Practice 208D00000X
Emergency Medicine 207P00000X
Family Medicine 207Q00000X

* Indicates primary specialty

NPI Profile & details for GLENN GORDON

NPI Number 1538108261
Credentials MD
Entity Individual
Enumeration date 06/06/2006
Last updated 05/15/2018 - About 8 years ago
Sole proprietor1 No
Identifiers
  • OR License #: MD15934
  • CA Medicaid: XPY185053
  • OR Medicaid: 057141
  • WA Medicaid: 8280034
  • Other: 057221003 BCBS
  • Other: A018 CHAMPUS
  • Other: C89984 GROUP HEALTH
  • Other: C89984 LIPA
  • Other: J0475-05 PACIFIC SOURCE
  • Other: C89984 PROVIDENCE
  • Other: 76172 WASHINGTON L&I
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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