Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301072238 | MI |
N | 207X00000X | Orthopaedic Surgeon | MD2004-0315 | NM |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 4301072238 | MI |
NPI | 1518935121 |
---|---|
Provider Name | Robert Roland Gorman III |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 09/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1417961137 | BCBSM - BMH (01) | MI |
1518935121 | (05) | MI |
5194435 | (05) | MI |
H95100 | (02) |