Provider Demographics
NPI:1053421024
Name:DOWNEY, GORDON OLIVER (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:OLIVER
Last Name:DOWNEY
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 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 MICHIGAN ST NE
Practice Address - Street 2:SUITE 6300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2562
Practice Address - Country:US
Practice Address - Phone:616-486-6000
Practice Address - Fax:616-486-2065
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGD059209207VX0201X
MI4301059209207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0410266OtherBLUE CARE NETWORK
MIF27400Medicare UPIN
MIGD059209OtherSTATE LICENSE NUMBER
MI4399447Medicaid
0P51370001Medicare PIN
MI16-0410286-1OtherBCBS PROVIDER NUMBER