Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G9350 | TX |
Y | 208600000X | Surgeon | G9350 | TX |
N | 2086S0127X | Trauma Surgeon | G9350 | TX |
NPI | 1427157460 |
---|---|
Provider Name | Dennis C Gore |
First Address | Galveston, TX 77555-5302 |
Second Address | Galveston, TX 77555-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 17/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129059503 | (05) | TX |
E30400 | (02) | TX |