Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Jacob Samuel Gordner, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1124762026

Dr. Jacob Samuel Gordner, MD is a Diagnostic Radiology in Stanford, California. Graduated from Queen's School of Medicine in 2017, 9 years ago. Practices with Ellis Bandt Birkin Kollins and Wong PLLC, a 71-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
9
Trained at
Queen's School of Medicine
Licensed in
CA
In the registry since
2022
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

300 Pasteur Dr
Stanford, CA 94305-2296
Phone: (650) 725-1812
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X · Licence A175900 (CA)

Record details

NPI number1124762026
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 26, 2022
Last updated in NPPESApril 26, 2022
Certification dateApril 26, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolQUEEN'S SCHOOL OF MEDICINE
Graduated 2017 (9 years in practice)
Group practice Ellis Bandt Birkin Kollins And Wong Pllc — 71 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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