Basic Information
Provider Information
NPI: 1124134317
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCLAREN
FirstName: GORDON
MiddleName: DOUGLAS
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5901 E 7TH ST
Address2: HEMATOLOGY/ONCOLOGY SECTION (11/111-H)
City: LONG BEACH
State: CA
PostalCode: 908225201
CountryCode: US
TelephoneNumber: 5628268000
FaxNumber: 5628265515
Practice Location
Address1: 5901 E 7TH ST
Address2: HEMATOLOGY/ONCOLOGY SECTION (11/111-H)
City: LONG BEACH
State: CA
PostalCode: 908225201
CountryCode: US
TelephoneNumber: 5628268000
FaxNumber: 5628265515
Other Information
ProviderEnumerationDate: 08/22/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XG84769CAY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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