MEDICARE: ALVIN I GORE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD417462	PA
2	207Q00000X	Family Medicine Physician	A79731	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326042821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVIN I GORE MD

Provider Business Mailing Address
First Line	:	1165 MONTGOMERY DR # 1W20
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4801
Country	:	US
Telephone Number	:	707-303-8307
Fax Number	:	707-303-1992

Provider Business Practice Location Address
First Line	:	1165 MONTGOMERY DR # 1W20
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4801
Country	:	US
Telephone Number	:	707-303-8307
Fax Number	:	707-303-1992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/02/2021

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Directions to “ ALVIN I GORE MD” Practice Location

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