Healthcare Provider Details

I. General information

NPI: 1811016058
Provider Name (Legal Business Name): PETER A GORSKI M.D., M.P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S BOARD OF HILLSBOROUGH COUNTY 1002 E. PALM AVE
TAMPA FL
33605
US

IV. Provider business mailing address

1013 ROYAL PASS RD
TAMPA FL
33602-5724
US

V. Phone/Fax

Practice location:
  • Phone: 813-204-1701
  • Fax:
Mailing address:
  • Phone: 813-204-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38842
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberME 89219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: