Healthcare Provider Details

I. General information

NPI: 1275677403
Provider Name (Legal Business Name): GERALD GORESKY MDCM, FRCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR H3580, DEPARTMENT OF ANESTHESIA, SUMC
STANFORD CA
94305-2200
US

IV. Provider business mailing address

5338 OAK STREET
VANCOUVER BC
V6M2V4
CA

V. Phone/Fax

Practice location:
  • Phone: 650-723-5728
  • Fax:
Mailing address:
  • Phone: 778-329-2213
  • Fax: 403-770-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberG32773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: