Healthcare Provider Details

I. General information

NPI: 1457323123
Provider Name (Legal Business Name): MICHAEL EDWARD GORIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SHORE CTR W SUITE 103B
ALAMEDA CA
94501-5762
US

IV. Provider business mailing address

501 S SHORE CTR W SUITE 103B
ALAMEDA CA
94501-5762
US

V. Phone/Fax

Practice location:
  • Phone: 510-521-6510
  • Fax: 510-521-1465
Mailing address:
  • Phone: 510-521-6510
  • Fax: 510-521-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number00G342310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: