Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD435796 | PA |
Y | 2080P0216X | Pediatric Rheumatologist | Q3876 | TX |
NPI | 1245459551 |
---|---|
Provider Name | Mark Gorelik |
First Address | San Antonio, TX 78207-3108 |
Second Address | San Antonio, TX 78207-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 29/05/2015 |