Healthcare Provider Details

I. General information

NPI: 1295315570
Provider Name (Legal Business Name): PAYTON ANNE GORE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 GRANDVIEW PKWY STE 500
BIRMINGHAM AL
35243-3412
US

IV. Provider business mailing address

PO BOX 680060
FRANKLIN TN
37068-0060
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-3510
  • Fax:
Mailing address:
  • Phone: 877-848-1457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54374
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number183147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: