Dr. David Lake Gormsen
Pediatric Emergency Physician
1320 Mercy Dr Nw
Canton
, Ohio 44708-2614
Dr. David Lake Gormsen
Pediatric Emergency Physician
1320 Mercy Dr Nw
Canton
, Ohio 44708-2614
(330) 489-1487
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About
Features
Specialties
- Pediatric Emergency Physician
Languages spoken
- English
Location
First Address
- Dr. David Lake Gormsen
- 4189 Songbird Trl
- Stow, OH
- Zip : 44224-2572
- Fax : (330) 489-1487
- Phone : (330) 688-4160
Second Address
- Dr. David Lake Gormsen
- 1320 Mercy Dr Nw
- Canton, OH
- Zip : 44708-2614
- Fax : (330) 489-1487
- Phone : (330) 489-1074
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207PP0204X | Pediatric Emergency Physician | 34002838 | OH |
National Provider Identifier
| NPI | 1619014602 |
|---|---|
| Provider Name | Dr. David Lake Gormsen |
| First Address | Stow, OH 44224-2572 |
| Second Address | Canton, OH 44708-2614 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 31/01/2007 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 34002838 | MEDICAL LICENSE NUMBER (01) | OH |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.