Healthcare Provider Details

I. General information

NPI: 1265403513
Provider Name (Legal Business Name): ANDREW GORMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 W THUNDERBIRD BLVD STE 200
SUN CITY AZ
85351-3015
US

IV. Provider business mailing address

PO BOX 2099 85372-2099
SUN CITY AZ
85372-2099
US

V. Phone/Fax

Practice location:
  • Phone: 855-506-3876
  • Fax: 855-523-0513
Mailing address:
  • Phone: 855-506-3876
  • Fax: 855-523-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number3871
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number3871
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number3871
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number3871
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: