Healthcare Provider Details

I. General information

NPI: 1336114800
Provider Name (Legal Business Name): RACHELLE L GORRELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N JEFFERSON ST
SAINT JAMES MO
65559
US

IV. Provider business mailing address

1050 W 10TH ST
ROLLA MO
65401-2905
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-8840
  • Fax: 573-202-2474
Mailing address:
  • Phone: 573-364-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2001007763
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: