MEDICARE: GARY D GORMAN M.D.

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	2084P0800X	Psychiatry Physician	ME62216	FL

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
2	ME62216	OTHER	FL	LICENSE
3	27636	OTHER	FL	BCBSF

General Provider Information

NPI Number	:	1760482509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY D GORMAN M.D.

Provider Business Mailing Address
First Line	:	217 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4916
Country	:	US
Telephone Number	:	850-348-6564
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4916
Country	:	US
Telephone Number	:	850-348-6564
Fax Number	:

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	03/07/2023

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