Healthcare Provider Details

I. General information

NPI: 1477125524
Provider Name (Legal Business Name): MRS. PATRICIA EVANS GORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BIRMINGHAM VA HEALTH CARE SYSTEM 700 19TH STREET S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

BIRMINGHAM VA HEALTH CARE SYSTEM 700 19TH STREET S
BIRMINGHAM AL
35233-1927
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8101
  • Fax: 205-939-4585
Mailing address:
  • Phone: 205-933-8101
  • Fax: 205-939-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: