Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 4301049958 | MI |
Y | 208000000X | Pediatrician | 2206028760 | MO |
N | 208000000X | Pediatrician | 4301049958 | MI |
NPI | 1164432720 |
---|---|
Provider Name | Jerome L Gorski |
First Address | Columbia, MO 65205-7687 |
Second Address | Columbia, MO 65201-6986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 16/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1736383 | (05) | MI |
206268807 | (05) | MO |
A79111 | (02) |