DR. GLENN GORDON MD NPI 1538108261

NPI Information

NPI: 1538108261
Provider Name: DR. GLENN GORDON, MD
Classification: General Practice - 208D00000X
Entity Type: Individual
Address:
2073 OLYMPIC ST
SPRINGFIELD, OR
ZIP 97477
Phone: (541) 682-3550
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DR. Glenn Gordon, MD is a general practice in Springfield, OR. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee DR. Glenn Gordon, MD NPI is 1538108261. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2073 OLYMPIC ST
SPRINGFIELD, OR
ZIP 97477
Phone: (541) 682-3550

The enumeration date for this NPI number is 6/6/2006 and was last updated on 5/15/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	207P00000X	Emergency Medicine	MD15934	OREGON	No
2	207Q00000X	Family Medicine	MD15934	OREGON	No
3	208D00000X	General Practice	MD15934	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	057141	MEDICAID	OREGON
2	76172	OTHER		WASHINGTON L&I
3	8280034	MEDICAID	WASHINGTON
4	C89984	OTHER		LIPA
5	057221003	OTHER		BCBS
6	J0475-05	OTHER		PACIFIC SOURCE
7	A018	OTHER		CHAMPUS
8	C89984	OTHER		GROUP HEALTH
9	C89984	OTHER		PROVIDENCE
10	XPY185053	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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