Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME127830 | FL |
NPI | 1003136987 |
---|---|
Provider Name | Dr. Ethan Mccaleb Gore |
First Address | Pensacola, FL 32514-6050 |
Second Address | Pensacola, FL 32514-6050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 24/05/2016 |