Provider Demographics
NPI:1588901219
Name:BRION, GORDON VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:VINCENT
Last Name:BRION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4779
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263
Mailing Address - Country:US
Mailing Address - Phone:323-823-3320
Mailing Address - Fax:760-699-5482
Practice Address - Street 1:3900 SHERMAN WAY
Practice Address - Street 2:ATTN: MVT PROGRAM
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:90253
Practice Address - Country:US
Practice Address - Phone:323-823-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-754662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry