Healthcare Provider Details

I. General information

NPI: 1245869171
Provider Name (Legal Business Name): DHAIRYA MARKANDRAY GOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 LITTLE RD
TRINITY FL
34655-1813
US

IV. Provider business mailing address

3611 LITTLE RD
TRINITY FL
34655-1813
US

V. Phone/Fax

Practice location:
  • Phone: 833-421-0312
  • Fax:
Mailing address:
  • Phone: 888-246-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4351051698
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: