| Doctor Name: | JASON GORDON |
| NPI Number: | 1174934764 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CLINICAL SOCIAL WORK |
| License Number: | |
| Business Practice Address: | 1st Street Holloman Afb Holloman Afb, NM - 88330 |
| Business Phone Number: | 5755720000 |
| Business Fax Number: | |
| Mailing Address: | Po Box 10, LA MESA |
| State: | CA |
| Postal Code: | 919440010 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/16/2014 |
| NPI Last Update Date: | 02/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |