Provider Demographics
NPI:1174209845
Name:GORDEN, WILLIAM RAY
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RAY
Last Name:GORDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-3780
Mailing Address - Country:US
Mailing Address - Phone:559-213-3520
Mailing Address - Fax:
Practice Address - Street 1:1900 N GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1622
Practice Address - Country:US
Practice Address - Phone:559-213-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator