Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 7771A | WY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 7771A | WY |
NPI | 1194858357 |
---|---|
Provider Name | Dr. Matthew Gorman |
First Address | Casper, WY 82609-3265 |
Second Address | Casper, WY 82609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 15/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
315221 | BCBS (01) | WY |
P00412109 | RAILROAD MEDICARE PTAN (01) | WY |