Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | P9579 | TX |
Y | 207PP0204X | Pediatric Emergency Physician | P9579 | TX |
N | 207RC0200X | Critical Care Medicine | P9579 | TX |
NPI | 1336344787 |
---|---|
Provider Name | Marina V. Gore |
First Address | Fort Sam Houston, TX 78234-4504 |
Second Address | Fort Sam Houston, TX 78234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2007 |
Last Update Date | 03/12/2019 |